High clearances produce low trough concentrations of antibiotic, with important implications for underdosing and the development of antibiotic resistance. We have shown that some patients with normal serum creatinine levels have very high creatinine clearance rates in ICU patients with sepsis, blood pressure and tissue perfusion are maintained with large fluid loads and inotropic agents, thereby raising creatinine clearance. She already gets out of her bra as soon as she gets home, so shes already quite at ease. My husband would like to say no, I am inclined to allow her to. Shell get dressed she says when people arrive but she would like to be at ease so she calls it.
Clinically, these kill characteristics translate into the need for appropriate doses of the various antibiotics in patients with sepsis. My daughter (14) wants to go topless at home. Kill characteristics of other antibiotics, such as aminoglycosides, relate to adequate peak concentrations and a significant post-antibiotic effect. For Beta- lactam antibiotics, the kill characteristic is almost entirely related to the time that tissue and plasma levels exceed a certain threshold, with no significant post-antibiotic effect, particularly against gram-negative organisms. Evaluation of the kill characteristics of antibiotics in experimental models suggests that different classes of antibiotics should have different dosing regimens. In our ICU, provided the infection source is controlled, we seldom use antibiotic courses longer than 7 days. Pseudomonas pneumonia probably needs a 7-10 day course. an expression the speaker says to the listener to encourage the listener to be extravagant, to go all the way, and do whatever you are doing to its fullest - and not flake out. There is an international trend to use shorter antibiotic courses. For nosocomial sepsis, broad-spectrum antibiotics must be started as soon as the relevant samples have been taken for culture, with de-escalation of therapy targeted to the causative organisms when results and susceptibilities are available. This means covering all possible causative organisms with the initial empirical choice. There is now significant evidence that initial use of the correct antibiotic saves more lives than virtually all other intensive care therapy.
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