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

• Published in: Clinical infectious diseases Vol. 36; no. 8; pp. 1006 - 1012
• Main Authors: Eliopoulos, George M., Paterson, David L., Rice, Louis B.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 15.04.2003; University of Chicago Press
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotic resistance; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antimicrobial Resistance; Antimicrobials; Biological and medical sciences; Cephalosporins; Communicable Diseases - drug therapy; Communicable Diseases - epidemiology; Critical Illness - mortality; Disease Outbreaks; Drug Resistance, Microbial; Drug Utilization; Empirical adequacy; Health outcomes; Humans; Infections; Intensive Care Units; Medical sciences; Pharmacology. Drug treatments; Rotation; Treatment Outcome; Ventilator associated pneumonia; Human; Infection; Antibiotic; Chemotherapy; Choice; Prognosis; Treatment; Critically ill; Antibacterial agent
• ISSN: 1058-4838; 1537-6591; 1537-6591
• DOI: 10.1086/374243

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.