Optimal antimicrobial therapy: the balance of potency and exposure

Antimicrobial therapy has evolved to be an essential component for treating bacterial infection; however, the optimal duration of therapy continues to be defined for a number of different infections. Previously, uncomplicated infections of the lower and upper urinary tracts required treatment durations of 10-14 days and can now be successfully managed with < or = 3-7 days of oral therapy. Similarly, optimal durations of therapy for community-acquired respiratory tract infections continue to be defined with shorter durations being approved, based on the clinical outcome of comparative trials. The shorter durations of therapy are thought to clearly benefit patient care with improved compliance. But, are all of the approved antimicrobial compounds ideal for shorter durations of therapy? Optimal use of these compounds involves re-evaluating each drug's antimicrobial spectrum, pharmacological characteristics, clinical outcome and side-effects profiles, and a reduced likelihood of selecting drug-resistant bacteria during therapy (due to the current environment of global antimicrobial resistance and fewer new antimicrobials under development).