Antibacterial therapy. II. Some considerations of specific treatment of selected bacteremic infections
Martin C. Mchenry, M.D.
Department of Internal Medicine, Section of Infectious Disease
IT seems unlikely that it will ever be possible automatically to administer antibacterial therapy safely and effectively without prior deliberation. This deliberation is necessary because of the complexity and variability of patients, pathogens, infections, antibacterial drugs and their interaction. In the companion report (I),1 some general aspects of the strategy of antibacterial therapy are presented. This report is concerned with specific antibacterial therapy of selected bacteremic infections, including those due to gram-negative bacilli, coagulase-positive staphylococci, streptococci, pneumococci, meningococci, and clostridial organisms.
Bacteremia due to gram-negative bacilli
Bacteremia due to gram-negative bacilli is now a common cause of shock and death in hospitalized patients.2, 3 Hemodynamic derangements may vary widely among patients whose disorders are diagnosed as bacteremic shock, or at different stages of disease in a specific patient. Underlying diseases and therapies often are of paramount importance in the pathogenesis and eventual outcome of the bacteremia.
The most frequent pathogens are Escherichia coli, Klebsiella-Enterobacter, Pseudomonas, Proteus, and Bacteroides. Because of the fulminating nature of the infection, treatment must frequently be started before the results of cultures or in vitro susceptibility tests are available; knowledge of the location of the primary infection and certain clinical clues may often lead to suspicion of the pathogen. The susceptibility pattern of gram-negative bacilli is somewhat unpredictable and may vary in different geographic locations. Antibiotics that are most likely to be effective often are those that have the greatest potential for toxicity.
Commercially available antibiotics having possible application in gram-negative bacteremia and some of the . . .