Infectious disease clinics of North America
-
Infect. Dis. Clin. North Am. · Sep 2004
ReviewPathogens resistant to antimicrobial agents: epidemiology, molecular mechanisms, and clinical management.
Resistance to antimicrobial drugs is increasing at an alarming rate among both gram-positive and gram-negative bacteria. Traditionally, bacteria resistant to multiple antimicrobial agents have been restricted to the nosocomial environment. A disturbing trend has been the recent emergence and spread of resistant pathogens and resistance traits in nursing homes, the community, as well as in hospitals. This article reviews the epidemiology, molecular mechanisms of resistance, and treatment options for pathogens resistant to antimicrobial drugs.
-
Infect. Dis. Clin. North Am. · Sep 2004
ReviewMacrolides and ketolides: azithromycin, clarithromycin, telithromycin.
The advanced macrolides, azithromycin and clarithromycin, and the ketolide telithromycin are structural analogues of erythromycin. They have several distinct advantages when compared with erythromycin including enhanced spectrum of activity, more favorable pharmacokinetics and pharmacodynamics, once daily administration, and improved tolerability. This article reviews the pharmacokinetics, antimicrobial activity, clinical use, and adverse effects of these antimicrobial agents.
-
Infect. Dis. Clin. North Am. · Mar 2004
Historical ArticleOsler on typhoid fever: differentiating typhoid from typhus and malaria.
Early in the history of medicine, physician had a difficult time differentiating acute febrile illnesses without localizing signs. Typhoid fever and malaria share common features, which caused diagnostic problems during the 1800s. Physician even introduced a new term, typho-malaria, a testimony to their diagnostic confusion. ⋯ Osler is credited for debunking the term typho-malaria. His clinical description of typhoid fever remains unsurpassed. Clinicians still can benefit greatly from reading Osler's clinical description of typhoid fever.
-
The information gathered here helps to explain why risk factors in the development of VAP vary from series to series. It also explains why different investigators have found opposite effects when evaluating the antibiotics. ⋯ These observations suggest that risk factors vary depending on the exposure to risk (ie, length of stay or MV). This variable should be considered when stratifying patients for risk factor analysis and also in the design of clinical trials for VAP prophylaxis.
-
Infect. Dis. Clin. North Am. · Dec 2003
ReviewTreatment failures in patients with ventilator-associated pneumonia.
Treatment failures in patients with VAP are a complex issue and form a major challenge for clinicians. The following key elements inherent to a rational approach to treatment failures have been elucidated: (1) the presence of treatment failure must be thoroughly defined and assessed; (2) the many causes behind treatment failures must be realized, particularly the possibility of pneumonia-related and extrapulmonary reasons; (3) the recognition of different patterns of treatment failures as a useful framework for decisions about modalities and intensity of diagnostic reassessment; and (4) the establishment of a protocol for the search of pulmonary and extrapulmonary sites of infection and noninfectious causes of nonresponse. Only such a rational approach precludes the adverse effects of blind empiricism, which always implies a dangerous and costly overtreatment. Many issues related to treatment failures remain unsettled, and efforts will have to be made in the future to improve current clinical attitudes to treatment failures in VAP.