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Antibiotic treatment is nearly always instituted empirically and is often
continued with no isolate to direct specific treatment. Most trials assessed
this scenario and do not support a benefit for combination therapy.
Clinicians may still opt for combination empirical treatment to increase the
probability of appropriate empirical treatment, which has indeed been shown
to improve survival.90 91 Current evidence suggests that aminoglycoside
monotherapy may be inadequate for infections outside the urinary tract.10 92
93 Thus, for the purpose of enhancing antimicrobial spectrum,
aminoglycosides may constitute a poor choice. Combination treatment is
considered for patients with severe infections. However, these are the
patients most prone to harm by the addition of an aminoglycoside. With no
proved survival benefit, combination therapy may be unjustifiable. Several
studies, included in the overall and subgroup analyses, directly assessed
semiempirical combination versus monotherapy. These, similarly, do not
support combination therapy for specific pathogens, when detected. . The
Demon Becomes Angry When Rob had been hugged and kissed by his mother and
sisters, and even Mr
Joslyn had embraced him warmly, he gave them a brief account of his
adventures.