Management of Infectious Diseases

by Manoj Jain, Dilip Mathai

This manual is unique. Likely pathogens and suggested regimens are based on microbiological data, antimicrobial availability, and common practices. The limitations on availability of antibiotics and laboratory data are accounted for in the decision making. We have emphasized tuberculosis, HIV and malaria. In this book, attempted to tackle one of the broadest subjects in the field of internal medicine: The management of infectious diseases. It is an ambitious project as patients belonging to all genre fall prey to these common maladies, and these diseases transcend the traditional barriers of departments and specialties. In this manual provide guidelines, protocols and clinical algorithms, while avoiding pedantic clinical instruction in order to help you make therapeutic choices of drugs offering the best likelihood of pathogen eradication and clinical cure. While sharing experiences, we discovered that one of the drawbacks of our present system of medical instruction is the lack of knowledge and skill in disciplines like clinical microbiology, when physicians practice infectious diseases care management. Also, as the patient is the end user, physicians have to adequately evaluate trials of clinical efficacy while remaining focused on cost effectiveness. The above factors have been compounded by the lack of a structured infectious disease training program during internship and residency. Lack of these factors has resulted in use of antibiotics by clinicians based on anecdotal and peer experience. Studies have shown that physicians often do not follow clinical practice guidelines. The reasons are often multi-factorial: Unfamiliarity with products listed, disagreement with protocols used, or lack of scientific support against clinical outcome. External barriers may influence a doctor’s ability to comply with practical guidelines. The more common among these are lack of time, failure of a reminder system, or an environment which is not conducive to change, resulting in an all encompassing inertia which has to be overcome. This makes it all the more imperative that scientific guidelines be established, validated, and focused on cost effectiveness. The myriad of etiological agents (bacterial, parasitic, fungal and viral) persists, none really having been vanquished, while newer pathogens like HIV, opportunistic organisms and multiple drug resistant organisms continue to emerge. This has led to confusion in the ranks with an arbitrary, unregulated use of antimicrobials in medical practice. Organisms acquire new resistances as antimicrobials increase in numbers. Dynamic situations lead to nosocomial infections and prolonged stay in the hospital. In each instance it is only a variation of the degree of pathophysiological effects on the system, while drugs remain the same. Resistance to antibiotics in the community depends not only on the region but also on the type of practice. In most cases, treatment is initiated before culture and sensitivity results are available, guided by the symptoms of the patient and the experience of the clinician.

ADD TO FAVOURITES