Infectious Emergencies
We don't know why, but there are some gradients of infection - Luc Montagnier
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Antimicrobial Use in the Emergency Department – Pearls and Pitfalls
This article is designed to guide ED providers towards selecting the best empiric antimicrobial regimen for infections commonly treated in the ED. Each type of infection will be addressed by stating the most common pathogens, options for antimicrobial therapy, and pearls/pitfalls related to antimicrobial use in those infection types. Because vancomycin and piperacillin-tazobactam (Zosyn®) are often considered for empiric therapy (especially in patients with sepsis), we will also address if this combination is appropriate for each type of infection.
Resources
Antibiotics
Antibiotics shouldn't be started blindly (without a defined source of infection) unless the patient has septic shock or neutropenic fever.
Must Know Antimicrobial Regimens – Adults
Antibiotic treatment is not without side effects, and treatment started in the emergency department is frequently empiric. Therefore, an understanding of the most likely causative organisms as well as local patterns of susceptibility and resistance is paramount to adequate treatment, appropriate antibiotic selection, and responsible antibiotic stewardship.
Antibiotics for Facial Fractures
Antibiotic of choice: Augmentin BID x 1 week, or Clindamycin for one week in those with penicillin allergies.
Bacterial Endocarditis
ED management includes empiric antibiotics covering the most common pathogens and consultation with surgery particularly if the patient has valvular insufficiency.
Cellulitis Antibiotic Selection: Management Updates
The treatment of cellulitis has changed tremendously in the last ten years. With the development of community-acquired MRSA infections along with an increasing number of immunocompromised hosts, there is concern about missing MRSA if not treating cellulitis for it.
Common ED Medication Errors: Antibiotics
Probably the greatest threat to patients from antibiotic therapy is emerging antimicrobial resistance and complications such as Clostridium difficile colitis, and these two factors combined lead to at least 35 thousand deaths every year. For patients concurrently taking warfarin, ACE inhibitors / ARBs, NSAIDs, or sulfonylureas, avoid use of trimethoprim/sulfamethoxazole (TMP/SMX), if possible.
Emergency Department Infections In The Era Of Community-Acquired MRSA
Infection and wound management in the ED requires that the clinician understand the implications of the emergence of CA-MRSA. Traditionally, skin infections have been treated with beta-lactam agents, either a cephalosporin (eg, cephalexin) or an antistaphylococcal penicillin (eg, dicloxacillin); however, these older treatment paradigms and regimens for common infections may no longer hold true.
Empiric Antibiotic Selection in the ICU
Necrotizing Fasciitis - Pathogens include group A strep, anaerobes, MRSA, and the occasional gram negative – use linezolid + piperacillin/tazobactam or vancomcyin + piperacillin/tazobactam + clindamycin.
PEDs - UTI Empiric Antibiotics
Recommendation is to use Amoxicillin with Clavulanate (20-40 mg/kg/D divded TID).
Prophylactic Antibiotics in Anterior nasal Packing For Epistaxis
The role of prophylactic systemic antibiotics when anterior nasal packing is employed remains highly controversial. The authors of the American College of Emergency Physician’s Focus on Treatment of Epistaxis note that while direct evidence is lacking, “most sources recommend TMP/SMX, cephalexin, or amoxicillin/clavulanic acid to prevent sinusitis and toxic shock syndrome [TSS].”
Sepsis Update: Lactate, Antibiotics, and Procalcitonin
Lactate may be a better predictor of “badness” in our ED patients even if they have an adequate blood pressure and “look good.”
Taking Antibiotics Before Dental Visits May Cause Serious Side Effects 80% Prescribed Unnecessarily, Study Shows
Outside of the hospital, clindamycin is more likely to be prescribed by dentists than any other health care providers. Even a single dose of clindamycin can cause C. diff, or an allergic reaction. Amoxicillin is the antibiotic most commonly prescribed by dentists and it can cause severe allergic reactions even after a single dose.
The Diabetic Foot Infection: When and What Types of Antibiotics are Warranted?
The IDSA guidelines propose empiric antibiotic treatment recommendations for DFI based on infection severity and causative pathogen. The table below represents a concise summary of the IDSA treatment guidelines. The IDSA recommends 1-2 weeks of antibiotics for mild infections, 1-3 weeks for moderate, and 2-4 weeks for severe infections [3]. Remember to check with your pharmacists and institutional policies before following these guidelines.
Time to Antibiotics in Sepsis
There is no data driven or evidence based research that demonstrates time to antibiotic administration in severe sepsis/septic shock as a reliable quality metric. Sepsis is a heterogeneous spectrum of illness and as such, one size does not fit all.
Antimicrobial Use in the Emergency Department – Pearls and Pitfalls
This article is designed to guide ED providers towards selecting the best empiric antimicrobial regimen for infections commonly treated in the ED.
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