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3.7.8 - Principles of Antibiotic Use in Intensive Care

from Section 3.7 - Infection and Immunity

Published online by Cambridge University Press:  27 July 2023

By
James McKinlay  and
Alexander Fletcher
Edited by
Ned Gilbert-Kawai ,
Debashish Dutta  and
Carl Waldmann
Ned Gilbert-Kawai
Affiliation:
The Royal Liverpool Hospital
Debashish Dutta
Affiliation:
Princess Alexandra Hospital NHS Trust, Harlow
Carl Waldmann
Affiliation:
Royal Berkshire Hospital, Reading
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Summary

Key Learning Points

  1. 1. Take samples; ‘start smart’ antibiotics based on the likely organism, then focused cover.

  2. 2. If no improvement, consider changing/stopping antibiotics or fungal/viral infection.

  3. 3. Short courses are usually sufficient (3–8 days).

  4. 4. Infective source control is vital, including potential removal of indwelling lines.

  5. 5. Poor use of antibiotics encourages resistant organisms and worsens patient outcomes.

Keywords

antibioticpathogensGram stainsepsisculture
Type
Chapter
Information
Intensive Care Medicine
The Essential Guide
 , pp. 267 - 272
Publisher: Cambridge University Press
Print publication year: 2021

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References

References and Further Reading

Covington, EW, Roberts, MZ, Dong, J. Procalcitonin monitoring as a guide for antimicrobial therapy: a review of current literature. Pharmacotherapy 2018;38:569–81.CrossRefGoogle ScholarPubMed
Cunha, B, Hage, J, Schoch, P, Cunha, C, Bottone, E, Torres, D. Overview of antimicrobial therapy. In: Cunha, CB, Cunha, BA (eds). Antibiotic Essentials, 11th edn. Sudbury, MA: Jones & Bartlett; 2012. pp. 2–15.Google Scholar
Lamy, B, Dargère, S, Arendrup, MC, Parienti, J-J, Tattevin, P. How to optimize the use of blood cultures for the diagnosis of bloodstream infections? A state-of-the-art. Front Microbiol 2016;7:697.CrossRefGoogle ScholarPubMed
Leekha, S, Terrell, CL, Edson, RS. General principles of antimicrobial therapy. Mayo Clin Proc 2011;86:156–67.CrossRefGoogle ScholarPubMed
Vincent, J-L, Rello, J, Marshall, J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009;302:2323.CrossRefGoogle Scholar

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