Journal of chemotherapy
-
Journal of chemotherapy · Dec 1999
ReviewManagement of the critically ill patient with severe sepsis.
Sepsis is a common cause of morbidity and mortality among the critically ill patient population. However, no anti-sepsis therapy has yet been found to be effective and treatment is thus largely supportive. ⋯ Enteral nutritional support with specialized nutrients has beneficial effects on morbidity, and should be started early. Further research will allow better definition of the septic patient according to immune status and enable more effective targeting of future anti-sepsis treatments.
-
Journal of chemotherapy · Dec 1999
ReviewAntimicrobial action and pharmacokinetics/pharmacodynamics: the use of AUIC to improve efficacy and avoid resistance.
In in-vitro and in animal models, antibiotics show good relationships between concentration and response, when response is quantified as the rate of bacterial eradication. The strength of these in-vitro relationships promises their utility for dosage regimen design and predictable cure of human infections. Resistance is also predictable from these parameters, fostering a rational means of using dosing adjustments to avoid or minimize the development of resistant organisms. ⋯ This value is also highly predictive of the development of bacterial resistance. Antimicrobial regimens that do not achieve an AUIC of at least 125 cannot prevent the selective pressure that leads to overgrowth of resistant bacterial sub-populations. Indeed, there is considerable anxiety that conventional respiratory tract infection management strategies, which prescribe antibacterial dosages that may attain AUIC values below 125, are contributing to the pandemic rise in bacterial resistance levels.