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Response depends on a number of factors, including the patient (immunocompromised patients respond slower than immunocompetent patients), the site of infection (deep-seated infections such as osteomyelitis and endocarditis respond more slowly than superficial infections such as cystitis or cellulitis), the pathogen (virulent organisms such as S aureus respond more slowly than viridans streptococci; mycobacterial and fungal infections respond slower than bacterial infections), and the duration of illness (in general, the longer the symptoms are present, the longer it takes to respond) Thus, depending on the clinical situation, persistent fever and leukocytosis several days after initiation of therapy may not indicate improper choice of antibiotics but may be due to the natural history of the disease being treated In most infections, either a bacteriostatic or a bactericidal agent can be used In some infections (eg, infective endocarditis and meningitis), a bactericidal agent should be used When potentially toxic drugs (eg, aminoglycosides, flucytosine) are used, serum levels of the drug are measured to minimize toxicity and ensure appropriate dosage In patients with altered renal or hepatic clearance of drugs, the dosage or frequency of administration must be adjusted; it is best to measure levels in the elderly, morbidly

The const keyword is followed by a type, an identifier, the assignment operator (=), and the value to assign to the constant. This is similar to declaring a variable except that you start with the keyword const and symbolic constants must be initialized. Once initialized, a symbolic constant cannot be altered. For example, in the following declaration, 32 is a literal constant and FreezingPoint is a symbolic constant of type int:

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Some microorganisms are predictably inhibited by certain drugs; if such organisms are isolated, they need not be tested for drug susceptibility For example, most group A hemolytic streptococci are inhibited by penicillin Other organisms (eg, enteric gram-negative rods) are variably susceptible and often require susceptibility testing whenever they are isolated Organisms that once had predictable susceptibility patterns have now become resistant and require testing Examples include the pneumococci, which may be resistant to multiple drugs (including penicillin, macrolides, and TMP-SMZ) and the enterococci, which may be resistant to penicillin, aminoglycosides, and vancomycin

Copy files to the same location (duplicate) s Select files and folders (see section B.1) and then: Duplicate using the mouse by right-clicking the selected items (or pressing Control and single-clicking the selected items) and selecting Duplicate from the menu. Duplicate using the keyboard by pressing Command+D. Move files

Table 30 4 Drugs of choice for suspected or proved microbial pathogens, 20071

Suspected or Proved Etiologic Agent Gram-negative cocci Moraxella catarrhalis TMP-SMZ,2 a fluoroquinolone3 Cefuroxime, cefotaxime, ceftriaxone, cefuroxime axetil, an erythromycin,4 a tetracycline,5 azithromycin, amoxicillinclavulanic acid, clarithromycin Ciprofloxacin, ofloxacin Cefotaxime, ceftriaxone, ampicillin An erythromycin,4 a cephalosporin,7 vancomycin, TMPSMZ,2 clindamycin, azithromycin, clarithromycin, a tetracycline,5 certain fluoroquinolones3 An erythromycin,4 a cephalosporin,7 vancomycin, clindamycin, azithromycin, clarithromycin Cephalosporin,7 vancomycin TMP-SMZ,2 doxycycline, minocycline, a fluoroquinolone,3 linezolid, daptomycin, quinupristin-dalfopristin A cephalosporin,8 clindamycin Vancomycin, a cephalosporin,7 clindamycin, amoxicillinclavulanic acid, ticarcillin-clavulanic acid, ampicillin-sulbactam, piperacillin-tazobactam, TMP-SMZ2 Vancomycin gentamicin Linezolid, quinupristin-dalfopristin, daptomycin Tigecycline, minocycline, doxycycline, aminoglycosides,11 colistin Metronidazole Clindamycin, ticarcillin-clavulanic acid, ampicillin-sulbactam, piperacillin-tazobactam TMP-SMZ2 gentamicin; chloramphenicol gentamicin; doxycycline gentamicin Tetracycline,5 a fluoroquinolone3 Aminoglycoside, a fluoroquinolone,3 cefepime Imipenem or meropenem, aminoglycosides,11 a fluoroquinolone3 TMP-SMZ,2 oral cephalosporin Aztreonam Ampicillin, amoxicillin, doxycycline, azithromycin, clarithromycin, cefotaxime, ceftriaxone, cefuroxime, cefuroxime axetil, ampicillin-clavulanate Bismuth subsalicylate + tetracycline + metronidazole + PPI TMP-SMZ,2 aminoglycoside,11 imipenem or meropenem, a fluoroquinolone,3 aztreonam Doxycycline rifampin Drug(s) of First Choice Alternative Drug(s)

const int FreezingPoint = 32;

Neisseria gonorrhoeae (gonococcus) Neisseria meningitidis (meningococcus) Gram-positive cocci Streptococcus pneumoniae 8 (pneumococcus) Streptococcus, hemolytic, groups A, B, C, G Viridans streptococci Staphylococcus, methicillin-resistant Staphylococcus, non-penicillinaseproducing Staphylococcus, penicillinase-producing Enterococcus faecalis Enterococcus faecium Gram-negative rods Acinetobacter Prevotella, oropharyngeal strains Bacteroides, gastrointestinal strains Brucella Campylobacter jejuni Enterobacter Escherichia coli (sepsis) Escherichia coli (uncomplicated urinary infection) Haemophilus (meningitis and other serious infections) Haemophilus (respiratory infections, otitis) Helicobacter pylori Klebsiella Legionella species (pneumonia)

Somatoform disorders can occur focused on any organ system Vulnerability in one or more organ systems and exposure to family members with somatization problems play a major role in the development of particular symptoms, and the functional versus organic dichotomy is a hindrance to good treatment Clinicians should suspect psychiatric disorders in a number of conditions For example, 45% of patients complaining of palpitations had lifetime psychiatric diagnoses including generalized anxiety, depression, panic, and somatization disorders Similarly, 33 44% of patients who undergo coronary angiography for chest pain but have negative results have been found to have panic disorder In any patient presenting with a condition judged to be somatoform, depression must be considered in the diagnosis

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