Vancomycin can be used for gram-positive cocci, ceftriaxone for gram-negative cocci, and ceftazidime for gram-negative rods. Gram stain results should guide initial antibiotic choice. Almost any microorganism can be pathogenic in septic arthritis however, septic arthritis is caused by nongonococcal pathogens (most commonly Staphylococcus species) in more than 80 percent of patients. Synovial fluid analysis is also useful to help distinguish crystal arthropathy from infectious arthritis, although the two occasionally coexist. Isolation of the causative agent through synovial fluid culture is not only definitive but also essential before selecting antibiotic therapy. In the absence of peripheral leukopenia or prosthetic joint replacement, synovial fluid white blood cell count in patients with septic arthritis is usually greater than 50,000 per mm 3. Constitutional symptoms such as fever, chills, and rigors are poorly sensitive for septic arthritis. The acute onset of monoarticular joint pain, erythema, heat, and immobility should raise suspicion of sepsis. 1997 17:810-4.Prompt diagnosis and treatment of infectious arthritis can help prevent significant morbidity and mortality. Pharmacoeconomic impact of once-daily aminoglycoside administration. Hitt CM, Klepser ME, Nightingale CH, Quintiliani R, Nicolau DP. Development of guidelines for gentamicin dosing. Thomson AH, Duncan N, Silverstein B, Alcock S, Jodrell D. The evolution of aminoglycoside therapy: a single daily dose. ![]() Effectiveness and safety of once-daily aminoglycosides: a meta-analysis. Mega-analysis of meta-analysis: an examination of meta-analysis with an emphasis on once-daily aminoglycoside comparative trials. Single daily dosing of aminoglycosides in immunocompromised adults: a systematic review. A meta-analysis of extended-interval dosing versus multiple daily dosing of aminoglycosides. 1997 24:796-809.īailey TC, Little JR, Littenberg B, Reichley RM, Dunagan WC. A meta-analysis of the relative efficacy and toxicity of single daily dosing versus multiple daily dosing of aminoglycosides. Once-daily aminoglycoside dosing in immunocompetent adults: a meta-analysis. Aminoglycosides: single or multiple daily dosing? A meta-analysis on efficacy and safety. Galloe AM, Graudal N, Christensen HR, Kampmann JP. An improvement to current practice or a repeat of previous errors?. Aminoglycoside administration as a single daily dose. Circadian variations in serum levels and the renal toxicity of aminoglycosides in patients. Prins JM, Weverling GJ, van Ketel RJ, Speelman P. Baltimore: Williams and Wilkins 1991:403–31. Prevention of drug-induced nephrotoxicity in the intensive care unit. Aminoglycoside ototoxicity: influence of dosage regimen on drug uptake and correlation between membrane binding and some clinical features. Use of antimicrobial agents and drug resistance. Lortholary O, Tod M, Cohen Y, Petitjean O. Goodman and Gilman's The pharmacological basis of therapeutics. Aminoglycosides: the complex problem of antibiotic mechanisms and clinical applications. Douglas and Bennett's Principles and practice of infectious diseases. ![]() In: Mandell GL, Bennett JE, Dolin R, eds. In certain clinical situations, such as patients with endocarditis or pediatric patients, traditional multiple dosing is still usually recommended. Single daily dosing of aminoglycosides appears to be safe, efficacious and cost effective. Single daily dosing of aminoglycosides is possible because of their rapid concentration-dependent killing and post-antibiotic effect and has the potential for decreased toxicity. Avoiding prolonged use, volume depletion and concomitant administration of other potentially nephrotoxic agents decreases the risk of toxicity. Resistance is rare but increasing in frequency. ![]() They are also used for prophylaxis, especially against endocarditis. Aminoglycosides are used in the treatment of severe infections of the abdomen and urinary tract, as well as bacteremia and endocarditis. Gentamicin is the most commonly used aminoglycoside, but amikacin may be particularly effective against resistant organisms. They are particularly active against aerobic, gram-negative bacteria and act synergistically against certain gram-positive organisms. Aminoglycosides are potent bactericidal antibiotics that act by creating fissures in the outer membrane of the bacterial cell.
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