The success of antimicrobial therapy can be measured either clinically in terms of improvement in symptoms/signs or microbiologically as eradication of the infecting organism.
FAILURE OF ANTIMICROBIAL THERAPY
The success of
antimicrobial therapy can be measured either clinically in terms of improvement
in symptoms/signs or microbiologically as eradication of the infecting
organism.
Antimicrobials may
fail to cure an infection/ fever, or there may be relapses. This is rare when
antimicrobial therapy was begun, in the first place, on sound clinical and/or
bacteriological basis. When a real or apparent failure of the antimicrobial
regimen occurs, the diagnosis and therapy should be reviewed. One of the
following causes will usually be identified.
1.
Improper selection of drug, dose, route or
duration of treatment.
2.
Treatment begun too late.
3.
Failure to take necessary adjuvant measures,
e.g. drainage of abscesses, empyema, etc.; removal of renal stones, other
foreign bodies or infected gall bladder, adjustment of proper urinary pH in
case of urinary tract infection; cavity closure; control of diabetes, etc.
4.
Poor host defence—as in leukaemias, neutropenia
and other causes, especially if a bacteriostatic AMA is used.
5.
Infecting organism present behind barriers,
such as vegetation on heart valves (SABE), inside the eyeball, blood brainbarrier.
6.
Trying to treat untreatable (viral) infections
or other causes of fever (malignancy, collagen diseases).
7.
Presence of dormant or altered organisms (the
persisters) which later give rise to a relapse.
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