Importance of adequate initial antimicrobial therapy

Area of Science:

• Infectious Diseases
• Clinical Pharmacology
• Critical Care Medicine

Background:

• The established principle of appropriate antibiotic therapy for serious infections is debated, especially concerning nosocomial pneumonia.
• Recent data on antibiotic therapy adequacy and patient outcomes require review.

Purpose of the Study:

• To review recent data on the adequacy of antibiotic therapy and its impact on outcomes in serious infections.
• To evaluate the role of appropriate antibiotic therapy in bacteremia and nosocomial pneumonia.

Main Methods:

• A literature search was conducted for articles published between 1997 and 2004.
• Articles focusing on appropriate/inappropriate antibiotic therapy, adequate therapy, antibiotic resistance, and delayed therapy were identified and data abstracted.

Main Results:

• Appropriate and timely antibiotic therapy strongly correlates with improved outcomes in bacteremia, with exceptions noted for specific pathogens and high therapy appropriateness rates.
• Data for nosocomial pneumonia are less conclusive, with some patient subsets confounding results, though most studies indicate a benefit from appropriate therapy.
• The role of specific antibiotic classes, like carbapenems versus cephalosporins for extended-spectrum beta-lactamase-producing enteric bacteria, requires further investigation.

Conclusions:

• Appropriate antibiotic therapy is dimensionally complex, with timing and susceptibility-based selection being key determinants of improved outcomes in most serious infections.
• Dosing intervals and dose magnitude are also critical but less exhaustively studied factors influencing patient outcomes.
• Future strategies should consider 'resistance'-proof antibiotics for empiric therapy to potentially enhance patient outcomes.