Patient Care and Monitoring

1. Assess the patient's symptoms and/or laboratory results to determine if the empirical therapy is effective. Is the patient's fever resolving? Is the patient's WBC decreasing?

2. Review available microbiologic cultures and sensitivity to assess whether the initial antimicrobial regimen needs to be tailored?

3. Review any additional diagnostic tests to determine if treatment may be needed to prevent/minimize complications (e.g., emboli, congestive heart failure).

4. Evaluate therapeutic serum drug concentrations as appropriate (e.g., vancomycin and gentamicin).

5. Monitor serum creatinine in order to make appropriate renal adjustments of the antimicrobials as necessary.

6. Assess any repeat blood cultures and vital signs to determine continued treatment effectiveness.

7. Evaluate the patient for occurrence of any adverse drug reactions and possible drug allergies and/or drug interactions.

8. Develop a plan if the patient is going to continue therapy at home. Once defervescence has occurred, the patient may complete therapy outside the hospital by receiving the antimicrobials from an outpatient infusion center or through a home health agency.

9. Develop a follow-up plan to assess the resolution of infection once the patient has completed therapy. Assessment of any adverse events also should be conducted at this time.

10. Educate high-risk patients on the importance of taking prophylactic antibiotics prior to having certain dental procedures in an effort to prevent the future development of another infection. Stress the potential complications as well as the morbidity and mortality that are associated with IE and that taking precautions can minimize or prevent them.

Abbreviations Introduced in This Chapter

AHA American Heart Association

CFLT Colony-fbrming units

ESR Erythrocyte sediment at ion rate

H ACEK Group of bactcria consisting of Haemophilus spp.j Actinobacillus actinomycetemcomitans, Caniiobacterium hominis, Eikendla corrodentt anil KlngeQa kingae IE Infective endocarditis

IVI >Us IV drug users MiC Minimum inhibitory concentration

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