empirical regimen may require adjustment to provide appropriate coverage for the specific isolate(s). When the patient remains afebrile, the initial regimen should be continued for a minimum of 7 days. Therapy may need to be continued for at least 21–28 days or until the risk of infection has declined because of recovery of the immune system. A mass casualty situation may mandate the use of oral antimicrobials. Modification of therapy Modifications of this initial antibiotic regimen should be made when microbiological culture shows specific bacteria that are resistant to the initial antimicrobials. The modification, if needed, should be influenced by a thorough evaluation of the history, physical examination findings, laboratory data, chest radiograph, and epidemiological information. Antifungal coverage with amphotericin B may need to be added. If diarrhea is present, cultures of stool should be examined for enteropathogens (i.e., Salmonella, Shigella, Campylobacter, and Yersinia). Oral and pharyngeal mucositis and esophagitis suggest Herpes simplex infection or candidiasis. Either empirical antiviral or antifungal therapy or both should be considered. In addition to infections due to neutropenia, a patient with the Acute Radiation Syndrome will also be at risk for viral, fungal and parasitic infections. If these types of infection are suspected, cultures should be performed and appropriate medication started if indicated. References External links Armed Forces Radiobiology Research Institute, Uniformed Services University Infection in Radiation Sickness, Washington DC, USA Medical consequences of nuclear war. TRIAGE AND TREATMENT OF RADIATION-INJURED MASS CASUALTIES. Borden Institute 2000s Chapter 5 INFECTIOUS COMPLICATIONS OF RADIATION INJURY. Borden Institute 2000s Radiation health effects