Research Article| Volume 14, ISSUE 2, P283-308, April 01, 1998


      To better comprehend the antibiotic recommendations in this article, the reader should be cognizant of a number of clinical, microbiologic, pharmacologic, and epidemiologic observations, as well as fundamental pharmacodynamic concepts. Taking into consideration that empiric antimicrobial therapy in the critical care unit (CCU) is the norm rather than the exception, the clinician must be familiar with the suspected pathogens from infectious processes acquired both in the community and in the hospital. In fact, most often the actual causative pathogen(s) of a given infection is rarely determined with certainty. A fundamental understanding of pharmacodynamic concepts is essential; it forms the very basis for the design of dosing strategies that maximize clinical efficacy while minimizing toxicity.
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        • Anaisse E.
        • Solomkin J.S.
        Fungal infections: Approach to the surgical patient at risk for candidiasis.
        in: Wilmore D.W. Brennan M.F. Harken A.H. American College of Surgeons: Care of the Surgical Patient. Scientific American, New York1994: 2 (2)
        • Arnow P.M.
        • Quimosing E.M.
        • Beach M.
        Consequences of intravascular catheter sepsis.
        Clin Infect Dis. 1993; 16: 778-784
        • Barquist E.
        • Kirtow O.
        Occult adrenocortical dysfunction in the surgical ICU patient.
        The unsuspected diagnosis. Eastern Assoc for the Surgery of Trauma. Ninth Scientific Assembly, Orlando, FLJan. 10–13, 1996
        • Barriere S.L.
        Bacterial resistance to β-lactams, and its prevention with combination antimicrobial therapy.
        Pharmacotherapy. 1992; 12: 397-402
        • Bartlett J.G.
        • Mundy L.M.
        Community-acquired pneumonia.
        N Engl J Med. 1995; 333: 1618-1624
        • Chastre J.
        • Fagon J.
        • Trouillet J.L.
        Diagnosis and treatment of nosocomial pneumonia in patients in intensive care units.
        Clin Infect Dis. 1995; 21: S226-237
        • Cunha B.A.
        Drug fever.
        Postgrad Med. 1986; 80: 123-129
        • de Marie S.
        • Janknegt R.
        • Bakker-Woudenberg I.A.J.M.
        Clinical use of liposomal and lipid-complexed amphotericin B.
        Br Soc Antimicrob Chemother. 1994; 33: 907-916
        • Dropulic L.K.
        • Leslie J.M.
        • Eldred L.J.
        • et al.
        Clinical manifestations and risk factors of Pseudomonas aeruginosa infection in patients with AIDS.
        J Infect Dis. 1995; 171: 930-937
        • Drusano G.L.
        • Johnson D.E.
        • Rosen M.
        • et al.
        Pharmacodynamics of a fluoroquinolone antimicrobial agent in neutropenic rat model of pseudomonas sepsis.
        Antimicrob Agents Chemother. 1993; 37: 483-490
        • Dudley M.N.
        Pharmacodynamics and pharmacokinetics of antibiotics with special reference to fluoroquinolones.
        Am J Med. 1991; 91: 45S-50S
        • Fong I.W.
        • Cheng P.C.
        • Hinton N.A.
        Fungicidal effect of amphotericin B in urine: In vitro study to assess feasibility of bladder washout for localization of site of candiduria.
        Antimicrob Agents Chemother. 1991; 35: 1856-1859
        • Klepser M.E.
        • Patel K.B.
        • Nicolau D.P.
        • et al.
        Comparison of the bactericidal activities of ofloxacin and ciprofloxacin alone and in combination with ceftazidime and piperacillin against clinical strains of pseudomonas aeruginosa.
        Antimicrob Agents Chemother. 1995; 39: 2503-2510
        • Forrest A.
        • Nix D.E.
        • Ballow C.H.
        • et al.
        Pharmacodynamics of intravenous ciprofloxacin in seriously ill patients.
        Antimicrob Agents Chemother. 1993; 37: 1073-1081
        • Gilbert D.N.
        Once daily aminoglycoside therapy.
        Antimicrob Agents Chemother. 1991; 35: 399-405
        • Griffen J.J.
        • Meduri G.U.
        New approaches to the diagnosis of nosocomial pneumonia.
        Med Clin North Am. 1994; 78: 1091-1122
        • Hughes W.T.
        • Armstrong D.
        • Bodey G.P.
        • et al.
        Guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever.
        J Infect Dis. 1990; 161: 381-396
        • Maki D.G.
        Infection due to infusion therapy.
        in: Bennett J.V. Brachman P.A. Hospital Infection. Little, Brown, Boston1986: 561-580
        • Moore R.D.
        • Lietman P.S.
        • Smith C.R.
        Clinical response to aminoglycoside therapy: Importance of the ratio of peak concentration to minimal inhibitory concentration.
        J Infect Dis. 1987; 155: 93-99
        • Moosdeen F.
        The evolution of resistance to cephalosporins.
        Clin Infect Dis. 1997; 24: 487-493
        • Nicolau D.P.
        • Freeman C.D.
        • Belliveau P.P.
        • et al.
        Experience with once-daily aminoglycoside program administered to 2,184 adult patients.
        Antimicrob Agents Chemother. 1995; 39: 650-655
        • Nicolau D.P.
        • Quintiliani R.
        Choosing among the new cephalosporin antibiotics.
        Pharmacoeconomics. 1994; 5: 34-39
        • Nicolau D.P.
        • Crowe H.M.
        • Quintiliani R.
        • et al.
        Fluconazole administered by feeding tube is generally well-absorbed in patients with functioning gastrointestinal tracts.
        J Antimicrob Chemother. 1995; 36: 395-401
        • Nishida M.
        • Murakawa T.
        • Kaminura T.
        • et al.
        Bactericidal activity of cephalosporins in an in-vitro model simulating serum levels.
        Antimicrob Agents Chemother. 1978; 14: 6-12
      1. Owens RC, Ambrose PG, Quintiliani R, et al: Utilizing pharmacodynamic principles to classify quinolone antibiotics into generations. In Press/data on file. Antibiotics for Clinicians

      2. Owens RC Jr, Banevicius MA, Nicolau DP, et al: In vitro synergy between tobramycin and selected β-lactams against gram-negative nosocomial clinical isolates. In Press/data on file. Antimicrob Agents Chemother

      3. Preston SL, Drusano GL, Beramn AL, et al: Prospective development of pharmacodynamic relationships between measures of levofloxacin exposure and measures of patient outcome [Abstract]. In Programs and abstracts of the 36th Interscience Conference of Antimicrobial Agents and Chemotherapy, New Orleans, 1996, p 49

        • Quintiliani R.
        • Cooper B.W.
        • Briceland L.L.
        • et al.
        Economic impact on streamlining antibiotic administration.
        Am J Med. 1987; 82: 391-394
        • Read I.
        • Body G.P.
        Infectious complications of indwelling vascular catheters.
        Clin Infect Dis. 1992; 15: 197-210
        • Rex J.H.
        • Bennett E.
        • Sugar A.M.
        • et al.
        A randomized trial comparing fluconazole with amphotericin B for the treatment of candidemia in patients without neutropenia.
        N Engl J Med. 1994; 331: 325-330
        • Shaunak S.
        • Cohen J.
        Lack of toxicity of long-term, high total dose liposomal amphotericin B.
        J Antimicrob Chemother. 1994; 34: 451-452
        • Wingard J.R.
        • Merz W.G.
        • Rinaldi M.G.
        • et al.
        Increase in Candida kruesei among patients with bone marrow transplantation treated prophylactically with fluconazole.
        N Engl J Med. 1991; 325: 1274-1277
        • Winston D.J.
        • Emmanouilides C.
        • Busuttil R.W.
        Infections in liver transplant recipients.
        Clin Infect Dis. 1995; 21: 1077-1091