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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http://www.journals.uchicago.edu/CID/journal/issues/v36n8/21071/brief/21071.abstract.html

Clinical Infectious Diseases    2003;36:000
© 2003 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2003/3608-00XX$15.00

 

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ANTIMICROBIAL RESISTANCE INVITED ARTICLE

 George M. Eliopoulos, Section Editor

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

David L. Paterson1 and Louis B. Rice2

1Antibiotic Management Program, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and 2Medical Service, Louis B. Stokes Veterans Affairs Medical Center, and Department of Medicine, Case Western Reserve University, Cleveland, Ohio

 

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.

 


     Received 24 July 2002; accepted 24 December 2002; electronically published 3 April 2003.

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