Antibiotics and Outpatient Infections.pdf

When you are choosing an agent to use, you are looking at what clinical symptoms the patient has, who is this patient, an immunocompromised or normal host. You are taking a little bit more of a detailed history to include infectious risks, and you are thinking about the antibiotic itself.
In a clinical syndrome, you are trying to identify what is the predominant symptom and signs. You are trying to see where the site of infection is. Is this infection in the joint? Is this infection in the bone? Where are we treating this infection? Does this patient have a central nervous system infection? Then, identify the disease process because if you identify that this is osteomyelitis, it is a little bit different than if you think that the patient has pyogenic arthritis. The causative organisms might change and then what you need do, is you need to think of what the disease is, what are the most likely pathogens associated with this disease and what is their susceptibility pattern in the area where you practice. This is essential. To pick a drug, you have to know what organism you are dealing with. Because if not, you are really doing it blindly. So you have to have an idea of what organisms cause what specific diseases so that then you can make a good choice about antibiotic therapy.
When you look at hosts, you need to know the age of the patient. A 10-year-old is different from a neonate. The pathogens are different. Think about underlying conditions. Is this a patient with cystic fibrosis with pneumonia, or is this a well child with pneumonia? Different pathogens. So you are thinking about that host. Does this patient have an indwelling catheter? Does the patient have a prosthetic heart valve? All these things make it a little different to know which antibiotic to choose. Then, is the patient malnourished because that might be a cause for immunodeficiency.
When you are looking at a focused history, you need to know if the patient you are seeing with fever for 10 days has just come back from a safari in Africa, or is this a patient who has just been in the community where there is a lot of influenza. So you are going to ask about travel, about exposure to people who have contagious diseases such as tuberculosis, or whether the child is exposed to more infections because he is in daycare. Are immunizations up to date? That is very important. That patient may have measles if they have never been immunized and there is an increase in your community of Hemophilus influenza type E,. which is now very rare but can occur. Is this adolescent an IV drug abuser? Unfortunately, this happens occasionally and it brings in another set of organisms and diseases we have to think about, and then sexual activity brings up another whole host of organisms and disease processes.
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