Empiric antibiotics are not indicated for all patients with SIRS ( Table 4 ). Fever is not an indication for antibiotics. Indications for antibiotic therapy includes: suspected or diagnosed infection ( UTI , pneumonia, cellulitis , etc), hemodynamic instability, neutropenia (or other immunocompromised states) and asplenia (due to the potential for overwhelming postsplenectomy infection . OPSI). Empiric antibiotic therapy should be guided by available guidelines (most infectious disease syndromes are covered elsewhere in this manual) and knowledge of the local antibiotic antibiograms. One must also take into account the patient’s risk factors for resistant pathogens (antibiotic exposures, nursing home stay, and hospitalization) and allergies. Once a bacteriologic diagnosis is obtained, it is critical to narrow the antibiotic spectrum to the most appropriate therapy. If an infectious disease workup is negative, discontinuation of antibiotics may be indicated.
Contact lens wear can be an inflammatory influence under normal circumstances, but an alreadysensitized cornea can show rebound inflammation if proper steps aren’t taken. It is imperative to use the immunosuppressive benefits of steroids with a slow taper as contact lens wear is resumed, or the patient will suffer setbacks and require multiple office visits. We typically restart limited contact lens wear when the rehabilitating cornea can tolerate a limited steroid dosage of once to twice daily.
Before embarking on a long term course of corticosteroids the factors summarised in Table 1 should be considered. A full discussion with the patient is necessary in order to explain the benefits and risks of corticosteroid treatment. A patient information leaflet is now provided by the manufacturers of all systemic corticosteroid preparations. As emphasised by the recent publication by the Committee on the Safety of Medicines, 33 advice to patients is the key to the safe use of long term systemic corticosteroids and it recommends discussing the following points with the patient: