Infectious disease clinics of North America
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In the ICU, fever can be expected to accompany an extensive number of conditions of both infectious and noninfectious etiologies. It is crucial to identify the precise cause of fever, because certain conditions in either category may be life-threatening, whereas others require no treatment at all. It is important to rule out the most common infections that may be present based on historical and physical signs and symptoms and epidemiologic factors. ⋯ In no case should prolonged antibiotics be given for presumed but unproven infection. Thorough knowledge of the more common infectious and noninfectious conditions, as well as the awareness of less frequent ones and their predisposing risk factors, is essential for adequate evaluation of the febrile ICU patient. Likewise, familiarity with the techniques used for diagnosis of these infections and their appropriate interpretation and limitations in specific instances is immensely helpful to the clinician providing appropriate care for the critically ill patient.
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Many of the antimicrobial agents described here exhibit great advances over older drugs in terms of antimicrobial spectrum, clinical utility, and, sometimes, safety. The newer cephalosporins are useful for treatment of many common outpatient and inpatient infections. ⋯ These antimicrobials are expensive, however, and some offer no advantages over older agents. Finally, all--including imipenem--are faced with increasing resistance of bacteria.
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Infect. Dis. Clin. North Am. · Sep 1995
ReviewAntibacterial agents in infections of the central nervous system and eye.
Experimental animal models have provided much information that can be applied to antimicrobial therapy of infections of the central nervous system and eye. The efficacy of an antimicrobial agent in the therapy of meningitis depends upon its ability to penetrate the blood-brain barrier, be active in purulent cerebrospinal fluid, and demonstrate rapid bacterial activity against the offending pathogen. In ocular infections, topically administered drugs must overcome various barriers to penetrate into the eye, or these barriers must be bypassed (i.e., by periocular or intravitreal injection) for optimal therapy. This article reviews the basic therapeutic principles for the treatment of infections of the central nervous system and eye, and gives recommendations for the treatment of specific infections.
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Infect. Dis. Clin. North Am. · Sep 1995
ReviewThe newer macrolides. Azithromycin and clarithromycin.
Azithromycin and clarithromycin are structural analogues of erythromycin that have similar mechanisms of action. The newer macrolides have several distinct advantages over erythromycin, including improved oral bioavailability; longer half-life, allowing once or twice daily administration; higher tissue concentrations; and fewer gastrointestinal adverse effects. ⋯ New therapeutic roles include the use of azithromycin for C. trachomatis infections and the inclusion of clarithromycin or azithromycin as part of therapeutic regimens for disseminated MAC infections in HIV-infected patients. Further clinical trials are needed to determine the optimal roles for and uses of these new macrolides.
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Infect. Dis. Clin. North Am. · Jun 1995
Mass population displacement. A global public health challenge.
Since the end of the Cold War, there has been a dramatic increase in civil conflicts resulting in approximately 50 million refugees and internally displaced civilians. The public health impact of these situations has been immense, comprising high rates of communicable diseases, elevated prevalence of acute malnutrition, and high excess mortality rates. The prevention of these adverse public health effects includes early warning and intervention; prompt supply of adequate food, water, and sanitation; measles immunization; effective management of epidemic communicable diseases; and simple and timely information systems.