PUESTA AL DÍA EN MEDICINA INTENSIVA: EL ENFERMO CRÍTICO CON INFECCIÓNPolítica de antibióticos en pacientes críticosAntibiotic policy in critical patients
Section snippets
Introducción
Los antimicrobianos son fármacos utilizados con gran frecuencia en los servicios o unidades de cuidados intensivos (UCI). En la última década se ha demostrado que la administración precoz de antimicrobianos con espectro adecuado influye a corto plazo en una evolución favorable de los pacientes críticos1, 2, 3, 4, mientras que a largo plazo, los antimicrobianos favorecen la aparición de flora emergente y condicionan cambios en las resistencias en aquellos patógenos que forman parte del
Primera norma. «Utilizar antibióticos solo cuando existe la sospecha clínica o microbiológica de una infección»
Los antibióticos solo deben utilizarse, con finalidad terapéutica, cuando existe la sospecha clínica o microbiológica de infección, aunque en los pacientes críticos puede ser difícil diferenciar entre sepsis (respuesta inflamatoria sistémica frente a la infección) y síndrome de respuesta inflamatoria sistémica frente a otros estímulos inflamatorios de naturaleza no infecciosa (traumatismo, poliartritis, pancreatitis, hemorragia, entre otras) y que, inicialmente, cursan con la misma expresividad
Estrategias generales del uso de antibióticos en pacientes críticos
Con la finalidad de optimizar el uso de antibióticos en el entorno de los pacientes críticos se han propuesto diversas estrategias. Entre ellas destacan la desescalada terapéutica (de-escalation therapy), el ciclado de antibiótico (antibiotic cycling), el tratamiento anticipado (preemptive therapy) y la aplicación de parámetros pK/pD para ajustar la dosificación.
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Desescalada terapéutica (de-escalation therapy). Consiste en la administración inicial de un amplio tratamiento empírico con la
Conclusiones
La política de antibióticos aplicada a pacientes críticos debe basarse en el cumplimiento de un conjunto de normas básicas de uso de los antibióticos. Las estrategias propuestas en los últimos años para optimizar su efectividad y minimizar los efectos adversos deben aplicarse con cautela, se deben evaluar en todo momento los resultados conseguidos y adaptarlos a las necesidades de cada UCI en particular. Los programas de educación a los clínicos en el cumplimiento de las normas básicas de uso
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