Outcome evaluation

Therapeutic success is measured by the extent to which the care plan (a) resolves signs and symptoms, (b) eradicates the microorganism(s), (c) prevents relapses, and (d) prevents complications such as amputation. Patients should be evaluated for resolution of clinical signs and symptoms and normalization of laboratory tests (WBC, CRP, ESR, and cultures). Hospitalized patients should be examined daily. Improvement in clinical manifestations should be seen within 48 to 72 hours of initiation of IV antimicrobial therapy. In the outpatient setting, patients should be evaluated weekly during the initial 4 to 6 weeks of therapy. A reduction in CRP should be seen within 1 week of therapy and should be monitored weekly throughout therapy for a continued downward trend. ESR can also be monitored weekly although normalization will be slower than for CRP. Patients should also be monitored for antimicrobial tolerability and tox-icity (see Table 81-3). If poor response is noted, the following should be evaluated: (a) patient compliance, (b) significant drug-drug or drug-food interactions, (c) appropriate dosage to achieve therapeutic concentrations, (d) development of antimicrobial resistance necessitating a change in the treatment regimen, (e) need for additional imaging studies, and (f) diagnostic reevaluation. Treatment is considered successful if all clinical signs and symptoms are resolved and all laboratory tests have returned to normal following 4 to 6 weeks of appropriate treatment. Due to high rates of relapse, patients should have medical follow-up for at least 1 year following resolution of symptoms. Patients should be evaluated at 3- to 6-month intervals for any clinical manifestations of recurring infection and continued normalization of laboratory tests. Follow-up imaging studies at 1 to 2 years may be useful in some patients to confirm therapeutic success.

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