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Streptococcus Pneumoniae

S pneumoniae may exist in humans as either a nasopharyngeal colonist or as a pathogen in one of many clinical syndromes (Box 1). Although S pneumoniae has been found in other mammals, humans are thought to be the principal reservoir. As a colonist, S pneumoniae is found in up to 40% of children and 10% of adults.

Pneumonia

This section focuses on the clinical findings, diagnosis, and treatment of pneumococcal pneumonia. Bacteremia, progressive respiratory failure, and hemodynamic instability (ie, septic shock) are the most severe complications of pneumococcal pneumonia. As noted above, patients with either anatomic or functional asplenia are at particularly high risk for sepsis. Spread of infection via either contiguous extension or hematogenous routes constitutes the basis of extrapulmonary complications.

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Intravenous clarithromycin caused thrombophlebitis in four patients when it was given inappropriately as a rapid bolus injection instead of a short infusion; the manufacturers have received other reports of similar reactions, even with infusions, but the incidence seems to be considerably lower than with erythromycin. In a prospective, non-randomized study, phlebitis occurred in 15 of 19 patients treated with intravenous erythromycin (incidence rate of 0.40 episodes/patient-day) and in 19 of 25 patients treated with intravenous clarithromycin (0.35 episodes/patient-day).

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Preclinical and clinical trial data and data from phase IV studies have suggested that levofloxacin causes prolongation of the QT interval. There were cardiovascular problems in 1 in 15 million prescriptions compared with 1-3% of patients taking sparfloxacin, who had QTC prolongation to over 500 ms.

Infectious disorders

Infectious diseases comprise those illnesses that are caused by microorganisms or their products. Clinical manifestations of infection occur only when sufficient tissue injury has been inflicted directly by microbial products (e.g., endotoxins and exotoxins), or indirectly by host responses (e.g., cytokines and hydrolytic enzymes released by polymorphonuclear leukocytes). Despite the extraordinary recent advances that have occurred in therapeutics for infectious diseases, a number of basic principles should be followed to prescribe antimicrobials and vaccines is an optimal manner.

Antimicrobial therapy: general principles

A wide variety of antimicrobial agents is available to treat established infections caused by bacteria, fungi, viruses, or parasites. This section will cover the general principles of antimicrobial therapy and will also include illustrative clinical problems to emphasize proper decision-making in using antimicrobials.

Toxicity of Antimicrobial Therapy

The mechanisms associated with common adverse reactions to antimicrobials include dose-related toxicity that occurs in a certain fraction of patients when a critical plasma concentration or total dose is exceeded, and toxicity that is unpredictable and mediated through allergic or idiosyncratic mechanisms. For example, certain classes of drugs such as the aminoglycosides are associated with dose-related toxicity.

Tetracyclines General Statement: Uses

Tetracyclines are used principally in the treatment of infections caused by susceptible Rickettsia, Chlamydia, Mycoplasma, and a variety of uncommon gram-negative and gram-positive bacteria.

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Norfloxacin is administered orally. The drug should be given with a glass of water at least 1 hour before or at least 2 hours after a meal or ingestion of milk or other dairy products.

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Adverse effects have occurred in about 7% of patients receiving a single 800-mg oral dose of norfloxacin for the treatment of uncomplicated gonorrhea. Dizziness, nausea, and abdominal cramping are the adverse effects reported most frequently in patients receiving this single-dose regimen, and these effects have been reported in 2-3.5% of patients.