Concept of empiric therapy with antibiotic combinations. Indications and limits.
It appears that the use of antibiotic combinations, especially synergistic ones, is indicated for the management of gram-negative bacillary sepsis in granulocytopenic patients. Synergism is a valuable factor in increasing the serum bactericidal activity, which is highly likely to be important for a favorable outcome in these infections. The potential side effects of antimicrobial combinations should not deter clinicians from their use. The most frequently used combinations for gram-negative bacillary infections are those involving beta-lactams and aminoglycosides. Other potentially synergistic combinations exist as well; however, the clinical experience with these combinations is limited, and, as with double beta-lactam combinations, their potential for antagonism necessitates care when using them. Besides gram-negative bacillary sepsis in granulocytopenic patients, severe staphylococcal infections might represent an indication for the use of combination therapy, especially in patients with compromised mechanisms of defense against infection.
D000380:Agranulocytosis / Q000150:complications*; D000617:Aminoglycosides / Q000008:administration & dosage; D000666:Amphotericin B / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000037:antagonists & inhibitors / Q000097:blood; D001424:Bacterial Infections / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D001770:Blood Bactericidal Activity; D004352:Drug Resistance, Microbial; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005334:Fever / Q000188:drug therapy; D006801:Humans; D007769:Lactams; D009181:Mycoses / Q000188:drug therapy; D018805:Sepsis / Q000188:drug therapy; D013203:Staphylococcal Infections / Q000188:drug therapy
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D007769:Lactams; D000666:Amphotericin B