Restrictive antibiotic policies are appropriate in intensive care units

Antibiotic use will always be an important part of medical practice in the intensive care unit. Antibiotic resistance increases the chance that empirical therapy will be inadequate to cover the organisms implicated in any particular infection. Therefore, strategies that can allow for optimal empirical antibiotic choice, while at the same time minimizing emergence of antibiotic resistance, are particularly important. In many situations, such strategies require some external stewardship of antibiotic use to be maximally effective. Antibiotic stewardship programs may take the form of management teams comprising infectious disease physicians and pharmacists. These clinicians work in concert with critical care specialists in choosing optimal empirical regimens and in streamlining therapy once culture results are available. Alternatively, computer-based clinical support systems have been developed that can guide physicians to utilize optimal antibiotic choices. External stewardship of antibiotic use may be particularly necessary in circumstances of increased antibiotic resistance, especially exhibited by Gram-negative bacilli. A number of examples exist in which antibiotic control programs can work when traditional infection control programs have failed. Mutation of organisms to produce antibiotic resistance is undoubtedly going to outstrip availability of new antibiotics in the near future. Antibiotic stewardship in concert with improved diagnostic methods may be our only hope in preventing endemic panresistant organisms.