Rational approaches to combating resistance

Traditional treatment paradigms based on national guidelines and administrative policies, such as restricted formularies, that are intended to guide antibiotic selection for empirical therapy of community- and hospital-acquired infections have been largely unsuccessful in curbing the spread of antimicrobial resistance. Evidence suggests that restricting antibiotic availability may lead to potential misuse of unrestricted agents as well as to increased adverse drug reactions, costs and, potentially, increased antibiotic resistance. New treatment paradigms, such as that embodied in the LDS Hospital computer-based "automated antibiotic assistant", that address antibiotic use from a process-of-care approach, using local clinician-derived solutions implemented at the patient's bedside, may offer strategic advantages over traditional approaches based on restricting antibiotic use. By using patient- and institution-specific data to tailor therapy to individual patient circumstances, such systems can help reduce the dosage, duration, frequency of adverse events and cost of antibiotic therapy as well as improving clinical outcomes and potentially avoiding drug resistance.