Antibiotics: the antipyretics of choice?
Article Abstract:
Fever is often treated with antibiotics without prior identification of the cause of the fever. The widespread use of antibiotics results in an increased incidence of: drug toxicities; complications of therapy, such as may occur with intravenous administration; growth of microorganisms that are resistant to antibiotics; misdiagnosis and inappropriate treatment; and wasted resources. Several studies have described the misuse of antibiotics. The author discusses his personal experience with the use of antibiotics to treat fever and the successes of his specific treatment approach. His criteria for using antibiotics to treat fever include: the presence of neutropenia, a low number of neutrophils (a type of white blood cell) or asplenia, the absence of the spleen; imbalance in circulatory functions; and evidence of bacterial infection. The decision to treat a fever with antibiotics should be individualized. Other factors that may contribute to the decision to use antibiotics are: the general health of the patient; presence of shaking chills; use of corticosteroids, which may decrease inflammatory signs of infection; existence of a potential source of infection; pattern and magnitude of fever; and leukocytosis, or an increase in the number of white blood cells. Cleansing of the infected area may be the most effective method of treating certain wounds, ulcers, and infections. The identity of the bacteria rather than the clinical context is often mistakenly used to determine the disease state and the need for antibiotic treatment. The decision to withhold or discontinue antibiotic treatment for fever should be continually assessed by physical examination of the patient and review of the patient's history, laboratory data, and X-ray findings. Fever is not a specific symptom and treatment with acetaminophen should be considered before using costly and potentially toxic antibiotics. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Quinolone toxicity: methods of assessment
Article Abstract:
The fluoroquinolones are a newer type of the quinolone antibiotics; this new group includes norfloxacin, ciprofloxacin, ofloxacin and temafloxacin. The fluoroquinolones are effective in killing a wider variety of bacteria than the quinolones and can be used to treat many bacterial diseases. They work well in the body, and fewer and milder side effects have been reported, compared with the quinolones. However, animal studies have indicated that certain areas in the body can be adversely affected by fluoroquinolones, including the kidneys, eyes, central nervous system and the joints of the young. The effects on the kidneys include mild interstitial nephritis (inflammation), blood in the urine, decreased function of the kidneys, increased weight of the kidneys, and the development of crystals in the urine. However, these effects are thought to be due to the precipitation of a foreign material in kidneys with urine that has a neutral or alkaline ion concentration (pH). Human urine is acidic and therefore these effects are not thought to occur in man. Clinical data do not lend any support to the occurrence of these side effects in the kidneys of humans. The effects on the eye, as observed in studies with dogs and cats, have not been detected in humans. However, effects on the central nervous system, such as convulsions, depression, anxiety, and the inhibition of sleep, have been known to occur in animals and humans treated with certain fluoroquinolones (enoxacin or ciprofloxacin) and fenuben. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Responsibility for patient care: where does the buck stop?
Article Abstract:
In teaching hospitals there is a collective responsibility for patients, with the attending physician taking ultimate responsibility. How much of this responsibility is relinquished is dependent on many factors, including whether the patient is a private or a ward patient. Delegation of some tasks by the attending physician is certainly necessary. The educational process is well served when the attending physician is directly involved with close supervision of less experienced physicians, which allows for confirmation of data, reinforcement of skills, and correction of errors. More careful and attentive doctors are created when they share equally and fully in the responsibilities of patient care. This parallel responsibility contrasts with the hierarchical delegation and division of responsibility seen in most teaching hospitals. The physician's challenge is to preserve the sanctity of individual doctor to individual patient care. Each physician involved in patient care carries with him the final 'buck stops here' responsibility. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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