Management with Antibiotics
Empiric antibiotic therapy is begun when the infection is so severe that waiting the 2-3 days before the culture and sensitivity (C&S) results return could be life-threatening or life-altering:
- Sepsis: Blood infection from bacteria which can result in hypotension (shock) and hypoperfusion to the organs, threatening their failure or the patient’s death.
- Meningitis: Usually viral, but in such a threat to brain function, there is more risk than benefit in not beginning antibiotics based on the traditional bacteria known to cause it.
- Sexually transmitted infections (STIs): When signs and symptoms are classic for a particular STI, e.g., purulent urethral discharge in gonorrhea, beginning antibiotics as early as possible with one known to be particularly effective will begin treating a patient’s severe pain as well as may preserve fertility.
- Septic arthritis: Early treatment will begin limiting permanent joint damage sooner rather than later.
- Pyelonephritis: Kidney infection, more ominous than a simple bladder infection, can result in scarring with far-flung ramifications, such as renal dysfunction and hypertension, which can then further create risk for cardiovascular disease.
- High fevers: When a high temperature is the only sign in an otherwise mysterious infection, broad-spectrum antibiotics can be given empirically to cover for sepsis or prevent the rapid anemia that can develop from the fever while other diagnostics are implemented.
- Postoperative infections: Surgery in specific areas of the body can risk infections with certain types of bacteria, e.g., anaerobic bacteria in pelvic surgery. These are usually mixed infections in which a multi-drug regimen is used to cover all of the usual suspects until cultures return; if cultures cannot be obtained, the multi-drug regimen can be administered empirically while observing for clinical improvement.
Antibiotic Therapy Based on Culture and Sensitivity
When the C&S indicates the specific bacterium (bacteria) causing the infection and the sensitivity identifies the antibiotics to which the infectious organism(s) is (are) sensitive, a full course based on standard recommendations is begun and continues to completion unless the patient develops an allergic reaction or demonstrates worsening of the infection. As such, beginning antibiotic therapy requires close surveillance so that a mid-course correction can be made when necessary.