78 ANTIMICROBIAL THERAPY
Harrison’s Manual of Medicine
Antimicrobial agents represent one of the twentieth century’s major contributions to human longevity and quality of life. They are among the most commonly prescribed drugs and may be lifesaving. Used inappropriately, however, they can drive up the cost of health care, cause drug interactions and other adverse events, and foster the emergence of resistant pathogens.
Adherence to several guiding principles will promote the most effective use of antimicrobial agents. (1) Whenever possible, material for diagnostic purposes (culture, stains, and special studies) should be obtained before the initiation of therapy so that the pathogen can be identified and its antimicrobial susceptibility determined. (2) Once the pathogen and its susceptibility are known, the antimicrobial therapy chosen should have the narrowest possible spectrum so that the emergence of resistance and the perturbation of the normal flora are minimized. (3) The choice of antimicrobial agent should be guided by the pharmacokinetic and adverse-reaction profile of active compounds, the site of infection, the immune status of the host, and evidence of efficacy from appropriate, well- designed clinical trials. (4) If other factors are equal, the least expensive regimen should be used.
See Table 78-1.
Table 78-1 Major Antibacterial Agents
See Chap. 102, Chap. 103, Chap. 104, Chap. 105, Chap. 106 and Chap. 107.
See Chap. 108 and Chap. 109.
See Chap. 110 and Chap. 111.
For a more detailed discussion, see Archer GL, Polk RE: Treatment and Prophylaxis of Bacterial Infections, Chap. 137, p. 867; Wright PW, Wallace RJ Jr: Antimycobacterial Agents, Chap. 168, p. 1017; Dolin R: Antiviral Chemotherapy, Excluding Antiretroviral Drugs, Chap. 181, p. 1092; Bennett JE: Diagnosis and Treatment of Fungal Infections, Chap. 200, p. 1168; and Moore TA: Therapy for Parasitic Infections, Chap. 212, p. 1192, in HPIM-15.