.Samples should be taken for culture and sensitivity
testing;‘blind’antibacterial prescribing for unexplained
pyrexia usually leads to further difficulty in establishing
the diagnosis;
.Knowledge ofprevalent organismsand their current
sensitivity is of great help in choosing an antibacterial
before bacteriological confirmation is available. Generally,
narrow-spectrum antibacterials are preferred to broad-
spectrum antibacterials unless there is a clear clinical
indication (e.g. life-threatening sepsis);
.Thedoseof an antibacterial varies according to a number
of factors including age, weight, hepatic function, renal
function, and severity of infection. The prescribing of the
so-called‘standard’dose in serious infections may result
in failure of treatment or even death of the patient;
therefore it is important to prescribe a dose appropriate to
the condition. An inadequate dose may also increase the
likelihood of antibacterial resistance. On the other hand,
for an antibacterial with a narrow margin between the
toxic and therapeutic dose (e.g. an aminoglycoside) it is
also important to avoid an excessive dose and the
concentration of the drug in the plasma may need to be
monitored;
.Therouteof administration of an antibacterial often
depends on the severity of the infection. Life-threatening
infections often require intravenous therapy.
Antibacterials that are well absorbed may be given by
mouth even for some serious infections. Parenteral
administration is also appropriate when the oral route
cannot be used (e.g. because of vomiting) or if absorption
is inadequate (e.g. in neonates and young children).
Whenever possible, painful intramuscular injections
should be avoided in children;
.Durationof therapy depends on the nature of the
infection and the response to treatment. Courses should
not be unduly prolonged because they encourage
resistance, they may lead to side-effects and they are
costly. However, in certain infections such as tuberculosis
or osteomyelitis it may be necessary to treat for prolonged
periods. Conversely a single dose of an antibacterial may
cure uncomplicated urinary-tract infections. The
prescription for an antibacterial should specify the
duration of treatment or the date when treatment is to be
reviewed.
Superinfection
In general, broad-spectrum antibacterial drugs such as the
cephalosporins are more likely to be associated with adverse
reactions related to the selection of resistant organisms e.g.
fungal infectionsorantibiotic-associated colitis
(pseudomembranous colitis); other problems associated with
superinfection include vaginitis and pruritus ani.
Antibacterial therapy
When the pathogen has been isolated treatment may be
changed to a more appropriate antibacterial if necessary. If
no bacterium is cultured the antibacterial can be continued
or stopped on clinical grounds.
Antibacterials, switching from parenteral to oral
treatment
The ongoing parenteral administration of an antibacterial
should be reviewed regularly. In older children it may be
possible to switch to an oral antibacterial; in neonates and
infants this should be done more cautiously because of the
relatively high incidence of bacteraemia and the possibility
of variable oral absorption.
Antibacterials for prophylaxis
In most situations, only a short course of prophylactic
antibacterial is needed. Longer-term antibacterial
prophylaxis is appropriate in specific indications such as
vesico-ureteric reflux.Notifiable diseases
Doctors must notify the Proper Officer of the local authority
(usually the consultant in communicable disease control)
when attending a patient suspected of suffering from any of
the diseases listed below; a form is available from the Proper
Officer.Anthrax
Botulism
Brucellosis
Cholera
Diarrhoea (infectious bloody)
Diphtheria
Encephalitis, acute
Food poisoning
Haemolytic uraemic syndrome
Haemorrhagic fever (viral)
Hepatitis, viral
Legionnaires’disease
Leprosy
Malaria
Measles
Meningitis
Meningococcal septicaemiaMumps
Paratyphoid fever
Plague
Poliomyelitis, acute
Rabies
Rubella
SARS
Scarlet fever
Smallpox
Streptococcal disease (Group A,
invasive)
Tetanus
Tuberculosis
Typhoid fever
Typhus
Whooping cough
Yellow feverNoteIt is good practice for doctors to also inform the
consultant in communicable disease control of instances of
other infections (e.g. psittacosis) where there could be a
public health risk.Sepsis, early management
gChildren identified as being at high risk of severe illness
or death due to suspected sepsis should be given a broad-
spectrum antibacterial at the maximum recommended dose
without delay (ideally within one hour). Microbiological
samples and blood cultures must be taken prior to
administration of antibiotics; the prescription should be
adjusted subsequently according to susceptibility results.
A thorough clinical examination should be carried out to
identify sources of infection. If the cause of infection is
identified, treat in line with local antibacterial guidance or
susceptibility results.
Children aged up to 17 years with suspected community-
acquired sepsis of any cause should be treated with
ceftriaxone p. 322. If the child is already in hospital or is
known to have previously been infected or colonised with
ceftriaxone-resistant bacteria, an alternative antibiotic
should be chosen following local guidelines. Children
younger than 3 months should also receive an additional
antibiotic that is active againstlisteria(such as ampicillin
p. 341 or amoxicillin p. 339 ).
Neonates who are in hospital with suspected sepsis within
72 hours of birth, should be treated with intravenous
benzylpenicillin sodium p. 338 and gentamicin p. 312.
Community-acquired sepsis in neonates (who are more than
40 weeks corrected gestational age) should be treated with
ceftriaxone p. 322 , unless already receiving an intravenous
calcium infusion. Neonates aged 40 weeks corrected
gestational age or below, or receiving an intravenous
calcium infusion, should receive cefotaxime p. 320 , dosed
according to age.
The need for intravenousfluids, inotropes, vasopressors
and oxygen should also be assessed without delay, taking
into consideration the child’s lactate concentration, systolic
blood pressure (in children over 12 years) and their risk of
severe illness or death. Children at high risk should be
monitored continuously if possible, and no less than every
30 minutes.BNFC 2018 – 2019 Bacterial infection 301
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