Keterangan
The rational use of antibiotics in critically ill patients is paramount to combating infections while minimizing the risk of antimicrobial resistance. Clinicians must base antibiotic selection on a thorough understanding of the patient's clinical condition, local epidemiology, and potential pathogens. Tailoring therapy through de-escalation strategies and incorporating diagnostic tools like blood cultures ensures targeted treatment. Additionally, adherence to dosing regimens and regular reassessment of the patient's response are essential to optimize efficacy and prevent unnecessary antibiotic exposure. This judicious approach aligns with antimicrobial stewardship principles, promoting patient safety and preserving the effectiveness of antibiotics for future use in critical care settings.
Ringkasan
- Antibiotics are a critical class of drugs that have saved more lives than any other medical intervention. Prescribing antibiotics based on fear is a problem, leading to overuse. The goal should be to follow evidence-based practices, especially since many cases of fever may not be due to bacterial infections.
- In cases of septic shock, bacterial meningitis, and suspected bacterial infections in immunocompromised patients, antibiotics should not be delayed. The appropriateness of the antibiotics, meaning selecting the right drug for the specific source of infection, is essential.
- In cases where the infection is non-life-threatening, it is reasonable to wait until the source is identified and the possible pathogens are determined. If there is low suspicion of a bacterial infection, a low procalcitonin value (less than 0.25) can further support not starting antibiotics.
- Avoid sending pan cultures, as this can lead to treating colonizers rather than true infections. Only send cultures from normally non-sterile body fluids when there is a strong suspicion that the site is the source of infection.
- Appropriate dosing of antibiotics is important, considering pharmacokinetics (what the body does to the antibiotic) and pharmacodynamics (what the antibiotic does to the bacteria). Adjustments should be made based on factors like volume of distribution and renal clearance.
- In cases of drainable focus, drainage is essential and should be prioritized over changing antibiotics. Antibiotics alone will not be effective without source control.
- When culture reports become available, adjust antibiotic regimes accordingly. Stop non-pivotal antibiotics and narrow the spectrum of coverage whenever feasible to reduce collateral damage and resistance development.
- Stop antibiotics in a timely manner, guided by clinical judgment, short-course therapy protocols, or serial procalcitonin assays. A procalcitonin level of less than 80% of the peak value or less than 0.5 µg/L suggests antibiotics can be stopped safely.
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