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Traitement antibiotique

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Book cover Sepsis grave et choc septique

Part of the book series: Le point sur … ((POINT))

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Résumé

La prescription d’une antibiothérapie adaptée est fondamentale dans la prise en charge précoce du choc septique. La prescription est toujours probabiliste et correspond à la mise en route d’un traitement avant l’établissement d’un diagnostic microbiologique. Comme souligné ailleurs, ce traitement peut être «issu de l’expérience et de l’observation plus que de la théorie», aussi bien que «basé sur du charlatanisme et indépendant de la pathologie ou des outils de diagnostic» [1]. Ainsi, une antibiothérapie probabiliste inadaptée peut-être définie comme l’absence d’antibiotique actif sur la bactérie responsable de l’infection, ou l’utilisation d’un antibiotique vis-à-vis duquel la bactérie responsable de l’infection est résistante. «Les antibiotiques à large spectre» seront employés dans le sens d’antibiotiques ayant une activité contre Pseudomonas aeruginosa, notamment l’imipénème, la pipéraciline + tazobactam, la ceftazidime, alors que «l’antibiothérapie à large spectre» sera employée dans le sens d’une association d’antibiotiques actifs sur P. aeruginosa ou le Staphylococcus aureus résistant à la méthycilline (SARM). Par exemple, l’association d’un aminoside à une β-lactamine est considérée comme une antibiothérapie à large spectre. Les antibiotiques à spectre réduit sont donc par exemple les β-lactamines sans activité sur P. aeruginosa (essentiellement la ceftriaxone, et l’amoxicilline + acide clavulanique).

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Authors
  1. J. Textoris
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  2. C. Martin
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  3. M. Leone
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Textoris, J., Martin, C., Leone, M. (2011). Traitement antibiotique. In: Sepsis grave et choc septique. Le point sur …. Springer, Paris. https://doi.org/10.1007/978-2-8178-0064-6_10

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  • DOI: https://doi.org/10.1007/978-2-8178-0064-6_10

  • Publisher Name: Springer, Paris

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