Tag Archives: Penicillin

Bacterial Meningitis: Antimicrobial Therapy

The initial management of the patient with suspected acute bacterial meningitis is empiric antimicrobial and adjunctive therapy begun immediately after obtaining blood for bacterial culture. Respiratory isolation for the first 24 hours of antimicrobial therapy is recommended only for patients with suspected meningococcal meningitis. Respiratory isolation is not required for patients with meningitis due to… Read More »

Delirium: Neuropathogenesis

Even though delirium has many different etiologies, its constellation of symptoms is largely stereotyped, with some considered core symptoms. Somehow, this diversity of physiological perturbations translates into a common clinical expression that may represent dysfunction ofcertain neural circuits (as well as neurotransmitters) —  that is, a final common neural pathway. The involvement of certain specific… Read More »

Pharmacotherapeutics

Pharmacotherapeutics is the study of how drugs are used to prevent or treat disease. Understanding why a drug is prescribed for a certain disease can assist you in prioritizing drug administration with other patient care activities. Knowing a drug’s desired and unwanted effects may help you uncover problems not readily apparent from the admitting diagnosis.… Read More »

Pharmacotherapy for OCD

Not long ago, obsessive-compulsive disorder was viewed as refractory to conventional therapies. Traditional talk therapy based on psychoanalytical principles was rarely successful in reducing the severity of obsessions or compulsions. The success rate with a range of different medications was just as disappointing. The 1980s witnessed renewed optimism about the prognosis of obsessive-compulsive disorder as… Read More »

Novel and Experimental Drug Treatments

A variety of alternative drug treatments have been used in obsessive-compulsive disorder. Of those considered here, intravenous clomipramine is the only treatment supported by a reasonable degree of empirical evidence. Several open-label trials suggested that intravenous administration of clomipramine may be helpful in patients refractory to oral clomipramine. Two double-blind trials lent support to the… Read More »

Principles of Antimicrobial Therapy

A governing principle in the treatment of infectious diseases is summarized by the aphorism “the right drug for the right bug,” a statement that is as complex as it is simple. This aphorism is particularly critical when considering infections involving the central nervous system (CNS) for two main reasons: (1) the blood-brain barrier (BBB) limits… Read More »

Pharmacodynamics Of Antimicrobial Agents In Bacterial Meningitis

Pharmacodynamics entails the interactions that occur between the antimicrobial agent and the pathogen, and, although separate from pharmacokinetic properties, is dependent on these processes with respect to localizing antimicrobials at sites of infection. There are several pharmacodynamic properties of antimicrobials relevant to bacterial meningitis, including bactericidal / bacteriostatic activity, time- versus concentration-dependent killing, and postantimicrobial… Read More »

Corticosteroid Effects On Antimicrobial CSF And Bacterial Killing

Bacterial growth and death in the cerebrospinal fluid (CSF) both result in the release of proinflammatory bacterial products, such as peptidoglycan or lipopolysaccharide (LPS) that worsen central nervous system inflammation. For example, lipopolysaccharide activates Toll-like receptor 4 signaling in a wide variety of cells, ultimately leading to nuclear factor kappa B (NF-kB)-mediated transcription of proinflammatory… Read More »

Empiric Antimicrobial Therapy For Bacterial Brain Abscess

As stated above, the bacteria found in brain abscesses correspond to predisposing conditions such as pathogenesis of infection, host immunity, or events leading to direct inoculation. These predisposing conditions must be considered when designing an empiric antimicrobial regimen for patients with brain abscesses. Table Empiric antimicrobial therapy for brain abscess delineates a number of predisposing… Read More »

Duration Of Antimicrobial Therapy For CNS Infections

Little information is available addressing the appropriate duration of therapy for most types of central nervous system infection. Some experimental and clinical data are available for the effective duration of bacterial meningitis, especially for meningitis caused by N. meningitidis. For nonmeningococcal meningitis, the recommended duration of therapy is 10-14 days, but this duration is based… Read More »