How to manage a suspected infection?

From the Guidelines

To manage a suspected infection, antimicrobial therapy should be initiated once a patient receives a diagnosis of an intra-abdominal infection or once such an infection is considered likely, and for patients with septic shock, antibiotics should be administered as soon as possible. The management of a suspected infection involves several key steps, including:

• Identifying the symptoms and seeking appropriate medical attention if they are severe or persistent
• Ensuring proper hygiene by washing the affected area with soap and water, and applying an antiseptic solution like povidone-iodine or hydrogen peroxide
• Using over-the-counter pain relievers such as acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or ibuprofen (400-600mg every 6-8 hours with food) to manage pain and fever
• For bacterial infections, a healthcare provider may prescribe antibiotics like amoxicillin (typically 500mg three times daily for 7-10 days) or azithromycin (500mg on day one, then 250mg daily for 4 days) 1
• Completing the full course of antibiotics even if symptoms improve
• Staying hydrated, resting adequately, and monitoring for worsening symptoms such as spreading redness, increased pain, fever above 101°F (38.3°C), or pus formation
• For patients with septic shock, such resuscitation should begin immediately when hypotension is identified, and for patients without evidence of volume depletion, intravenous fluid therapy should begin when the diagnosis of intra-abdominal infection is first suspected 1
• An appropriate source control procedure to drain infected foci, control ongoing peritoneal contamination by diversion or resection, and restore anatomic and physiological function to the extent feasible is recommended for nearly all patients with intra-abdominal infection 1

It is essential to note that the choice of antimicrobial therapy depends on the suspected infectious etiology, whether the infection is community-, healthcare-, or hospital-onset, and whether the patient is immunocompromised 1. Additionally, for patients with severe disease due to catheter-related infection, appropriate antimicrobial therapy should be given, and the CVC should be removed, cultured, and inserted into a different site 1.

In pediatric patients, the management of intravascular catheter–related infections is challenging, and removal of a catheter may not be feasible, especially in neonates 1. Initial antibiotic selection should be based on the expected identity and susceptibility of the isolate and should be modified when results are available from the clinical laboratory. Empirical therapy for suspected catheter-related infection should be based on local knowledge of the distribution of isolates by species and the susceptibility patterns of nosocomial pathogens.

Overall, the management of a suspected infection requires a comprehensive approach that includes prompt initiation of antimicrobial therapy, proper hygiene, pain management, and monitoring for worsening symptoms.

From the FDA Drug Label

To reduce the development of drug-resistant bacteria and maintain the effectiveness of Ceftriaxone for Injection and other antibacterial drugs, Ceftriaxone for Injection should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. Ceftriaxone for Injection is indicated for the treatment of the following infections when caused by susceptible organisms

Managing a suspected infection involves:

• Obtaining appropriate specimens for isolation of the causative organism and determination of its susceptibility to the drug
• Instituting therapy prior to obtaining results of susceptibility testing if necessary
• Considering local epidemiology and susceptibility patterns in selecting empiric therapy
• Using Ceftriaxone for Injection only to treat or prevent infections proven or strongly suspected to be caused by susceptible bacteria 2
• Selecting or modifying antibacterial therapy based on culture and susceptibility information when available 2
• Adding appropriate antichlamydial coverage when treating pelvic inflammatory disease and Chlamydia trachomatis is a suspected pathogen 2

From the Research

Managing a Suspected Infection

To manage a suspected infection, the following steps can be taken:

• Identify the causative organism and its susceptibility to antibiotics 3, 4
• Choose an appropriate antibiotic, such as ceftriaxone, based on the organism and its susceptibility 3, 5
• Administer the antibiotic at the recommended dose and frequency, taking into account the patient's age, weight, and renal function 3, 4, 6
• Monitor the patient's response to treatment and adjust the antibiotic regimen as needed 3, 5
• Be aware of potential drug interactions, such as the interaction between ceftriaxone, fenretinide, and acetaminophen 7

Antibiotic Options

Some antibiotic options for managing a suspected infection include:

• Ceftriaxone, a third-generation cephalosporin with a broad spectrum of activity against Gram-positive and Gram-negative bacteria 3
• Cefazolin, a first-generation cephalosporin with activity against Gram-positive bacteria 5
• Antistaphylococcal penicillins, such as nafcillin or oxacillin, with activity against Staphylococcus aureus 5

Special Considerations

Special considerations when managing a suspected infection include:

• Pediatric patients, who may require different antibiotic dosing and administration schedules 4, 6
• Patients with renal impairment, who may require adjusted antibiotic dosing 3
• Patients with a history of allergy or adverse reaction to antibiotics, who may require alternative treatment options 3, 6