General Principles of Antimicrobial Therapy

• Published in: Mayo Clinic proceedings Vol. 86; no. 2; pp. 156 - 167
• Main Authors: Leekha, Surbhi, MBBS, Terrell, Christine L., MD, Edson, Randall S., MD
• Format: Journal Article
• Language: English
• Published: Rochester, MN Elsevier Inc 01.02.2011; Mayo Foundation; Elsevier, Inc; Elsevier Limited; Mayo Foundation for Medical Education and Research
• Subjects: Analysis; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Anti-infective agents; Antibiotic Prophylaxis; Bacterial Infections - diagnosis; Bacterial Infections - drug therapy; Biological and medical sciences; Drug Monitoring; Drug Resistance, Bacterial; Drug therapy; Drug Therapy, Combination; General aspects; Guideline Adherence; Health aspects; Humans; Infection; Internal Medicine; Medical sciences; Microbial Sensitivity Tests; Practice Guidelines as Topic; Prescription writing; Symposium on Antimicrobial Therapy; United States; antimicrobial susceptibility testing; extended-spectrum β-lactamase; glucose-6-phosphate dehydrogenase; AST; G6PD; MIC; methicillin-resistant Staphylococcus aureus; UTI; minimum inhibitory concentration; OPAT; HIV; CSF; cerebrospinal fluid; MRSA; ESBL; human immunodeficiency virus; outpatient parenteral antimicrobial therapy; urinary tract infection; Medicine; Treatment; Antimicrobial agent; Recommendation
• ISSN: 0025-6196; 1942-5546
• DOI: 10.4065/mcp.2010.0639

Antimicrobial agents are some of the most widely, and often injudiciously, used therapeutic drugs worldwide. Important considerations when prescribing antimicrobial therapy include obtaining an accurate diagnosis of infection; understanding the difference between empiric and definitive therapy; identifying opportunities to switch to narrow-spectrum, cost-effective oral agents for the shortest duration necessary; understanding drug characteristics that are peculiar to antimicrobial agents (such as pharmacodynamics and efficacy at the site of infection); accounting for host characteristics that influence antimicrobial activity; and in turn, recognizing the adverse effects of antimicrobial agents on the host. It is also important to understand the importance of antimicrobial stewardship, to know when to consult infectious disease specialists for guidance, and to be able to identify situations when antimicrobial therapy is not needed. By following these general principles, all practicing physicians should be able to use antimicrobial agents in a responsible manner that benefits both the individual patient and the community.