Patient Encounter 3 Empirical Selection of Antibiotics

Based on the information presented, select an empirical antimicrobial regimen for this patient. Your plan should include

(a) a tentative infectious diagnosis or source, including likely pathogens or resistant organisms;

(b) a specific antimicrobial(s) regimen, including drug(s), dose, and route of administration;

(c) description of any ancillary treatments; and

(d) a rationale for your empirical antimicrobial selection based on drug- andpatient-specific considerations.

Antimicrobial agents must be used with caution in pregnant and nursing women. Some agents pose potential threats to the fetus or infant (e.g., quinolones, tetracyc-lines, and sulfonamides). For some agents, avoidance during a specific trimester of pregnancy is warranted (e.g., trimethoprim/sulfamethoxazole). Pharmacokinetic variables also are altered during pregnancy. Both the clearance and volume of distribution are increased during pregnancy. As a result, increased dosages and/or more frequent administration of certain drugs may be required to achieve adequate concentrations.

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This information can be obtained from a number of sources. '

Adherence is essential to ensure efficacy of a particular agent. Patients may stop taking their antibiotics once the symptoms subside and save them for a "future" infection. If the patient does not complete the course of therapy, the infection may not be eradicated, and resistance may emerge. Self-medication of saved antibiotics may be inappropriate and harmful and may select for resistant organisms. Poor patient adherence may be due to adverse effects, tolerability, cost, and lack of patient education.

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