Sometimes antibiotics fail or appear to fail, and the clinician must determine the
reasons for a suboptimal response. However, before concluding that an antibiotic has
failed, it is important to remember that, even when antibiotics have their desired
effect, the patient's response may not be immediate. Most immunocompetent patients
will show some clinical response to appropriate antibiotic therapy within 24 to 48
hours, although various objective parameters of the infectious process may lag behind
the overall clinical response. For example, patients with Rocky Mountain spotted fever
often feel better within 24 to 48 hours, but their fever may not begin to respond
for an additional 2 to 3 days. Similarly, patients with pneumonia frequently experience
a diminution in fever and toxicity in the first few days after institution of antibiotics,
but the chest radiograph does not immediately reflect the patient's improvement and
may actually appear to worsen before it ultimately improves. A similar observation
describes cerebrospinal fluid during therapy for bacterial meningitis, which may temporarily
worsen (ie, manifest a greater leukocytosis) even as the patient improves. Some classic
parameters of infection are atypical on presentation. For example, patients with severe
infection may develop leukopenia instead of leukocytosis, while others present with
hypothermia instead of fever. Such patients will “respond” to treatment of their infection
by an actual rise in white blood cell count or temperature.
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© 2006 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
