Appropriate Antibiotic Therapy - 12/12/18

Doi : 10.1016/j.emc.2016.08.003

Michael G. Allison, MD ^a, Emily L. Heil, PharmD ^b, Bryan D. Hayes, PharmD ^c,^⁎
^a Critical Care Medicine, St. Agnes Hospital, 900 South Caton Avenue, Baltimore, MD 21229, USA
^b Department of Pharmacy, University of Maryland Medical Center, 29 South Greene Street, Room 400, Baltimore, MD 21201, USA
^c Department of Emergency Medicine, University of Maryland Medical Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA

^∗Corresponding author.

Résumé

Prescribing antibiotics is an essential component of initial therapy in sepsis. Early antibiotics are an important component of therapy, but speed of administration should not overshadow the patient-specific characteristics that determine the optimal breadth of antimicrobial therapy. Cultures should be drawn before antibiotic therapy if it does not significantly delay administration. Combination antibiotic therapy against gram-negative infections is not routinely required, and combination therapy involving vancomycin and piperacillin/tazobactam is associated with an increase in acute kidney injury. Emergency practitioners should be aware of special considerations in the administration and dosing of antibiotics in order to deliver optimal care to septic patients.

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Keywords : Sepsis, Antibiotics, Antifungals, Obesity, Resistance, Acute kidney injury, Dosing

Plan

Key points

Introduction

Timing of antimicrobial therapy

Appropriate antibiotic selection

The role of cultures

Miscellaneous

Gram-negative Double Coverage

Acute Kidney Injury Risk with the Combination of Vancomycin and Piperacillin/Tazobactam

Dosing Considerations

Summary

	Disclosure: The authors have nothing to disclose.
	The article was copyedited by Linda J. Kesselring, MS, ELS, the technical editor/writer in the Department of Emergency Medicine at the University of Maryland, School of Medicine.