Journal Article

Empirical Antibiotic Choice for the Seriously Ill Patient: Are Minimization of Selection of Resistant Organisms and Maximization of Individual Outcome Mutually Exclusive?

George M. Eliopoulos, David L. Paterson and Louis B. Rice

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 36, issue 8, pages 1006-1012
Published in print April 2003 | ISSN: 1058-4838
Published online April 2003 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/374243
Empirical Antibiotic Choice for the Seriously Ill Patient: Are Minimization of Selection of Resistant Organisms and Maximization of Individual Outcome Mutually Exclusive?

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Mortality related to serious infections in intensive care units (ICUs) is highest if empirical therapy is not active against the organism causing the infection. However, excessive empirical therapy undoubtedly contributes to bacterial resistance to antibiotics, in turn potentially contributing to poor patient outcome. We have reviewed 3 strategies that are increasingly practiced to reduce the hazards of broad empirical therapy, while aiming to ensure that empirical therapy is adequate. The most widely practiced strategy is discontinuation or streamlining of empirical therapy when culture results are available. The second approach is to withdraw certain antibiotic classes (most notably, third-generation cephalosporins) from the ICU antibiotic armamentarium. The third strategy employed is antibiotic cycling. Although this has also appeared to be a successful strategy, currently published studies have used historical controls and thus may be subject to significant bias. Computer-assisted antibiotic prescribing in ICUs may supplement or replace such strategies in the future.

Journal Article.  4949 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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