Antibiotic therapy in septic shock.

Septic shock is a life-threatening illness characterized by hypotension, impaired organ function and/or failure, and metabolic abnormalities. Septic shock can develop in patients infected with a variety of gram-positive and gram-negative bacteria, viruses, fungi, rickettsiae, spirochetes, protozoa, and parasites. Immediate recognition, diagnosis, and treatment are key elements in reducing the morbidity and mortality associated with this condition. Rapid administration of appropriate antibiotics in correct doses plays a major role in patient survival. Infections with gram-negative bacteria appear to be associated with septic shock more than any other etiologic agent; therefore, antibiotic selection must include those drugs with superior gram-negative coverage. The selection of appropriate antibiotics should be based on sound clinical judgement plus knowledge of the antimicrobials used. The principles of rational therapy include the following: (1) know the type of microorganisms or suspected organism being treated; (2) be familiar with resistant organisms in both the community as well as the hospital; and (3) initiate combination therapy with a beta-lactam antibiotic plus an aminoglycoside or use monotherapy with either a carbapenem or selected third generation cephalosporin. After culture results are known, the antibiotic regimen should be narrowed to cover the specific infecting microorganism using the least expensive, least toxic antibiotic available. The beta-lactam antibiotics include all penicillins, cephalosporins, carbapenems, and monobactams. Penicillins with extensive gram-negative coverage include all the carboxy (carbenicillin, ticarcillin, and ticarcillin plus clavulanic acid) and ureido (piperacillin, mezlocillin, azlocillin) penicillins. The third generation cephalosporins (cefoperazone, cefotaxime, ceftazidime, ceftizoxime, ceftriaxone, and moxalactam) have the broadest gram-negative coverage within the cephalosporin family.(ABSTRACT TRUNCATED AT 250 WORDS)