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Updated: Jul 6, 2026

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
11:17

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Published on: August 30, 2018

Appropriate vs. inappropriate antimicrobial therapy

P G Davey1, C Marwick

  • 1Health Informatics Centre, Division of Community Health Sciences, Dundee, UK. p.g.davey@chs.dundee.ac.uk

Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases
|May 3, 2008
PubMed

Insights

Inappropriate antimicrobial treatment or delayed therapy increases patient morbidity and mortality. Early, appropriate treatment is crucial for better patient outcomes, though other risk factors also play a role.

Area of Science:

  • Infectious Diseases
  • Clinical Medicine
  • Pharmacology

Background:

  • Inappropriate antimicrobial treatment, defined as using an agent to which a pathogen is resistant, is linked to worse patient outcomes.
  • Delayed initiation of appropriate antimicrobial therapy also significantly increases morbidity and mortality.
  • Studies in ventilator-associated pneumonia, intra-abdominal infections, and bacteremia consistently show higher mortality with inappropriate therapy.

Purpose of the Study:

  • To analyze the impact of inappropriate antimicrobial treatment and delayed therapy on patient outcomes.
  • To compare the outcomes of patients switched from inappropriate to appropriate therapy versus those initially treated appropriately.
  • To highlight the importance of considering patient-specific risk factors alongside antimicrobial treatment efficacy.

Main Methods:

  • Review of studies investigating outcomes associated with antimicrobial treatment timing and appropriateness.
  • Analysis of mortality data in patients receiving inappropriate versus appropriate antimicrobial therapy.
  • Examination of the effect of switching therapy on patient outcomes.

Main Results:

  • Inappropriate therapy and delayed treatment are associated with increased morbidity and mortality.
  • Switching from inappropriate to appropriate therapy improves outcomes, but initial appropriate therapy yields the greatest benefit.
  • Accurate timing of infection onset is critical for assessing the impact of inappropriate therapy on outcomes like hospital stay.

Conclusions:

  • Inappropriate antimicrobial treatment significantly influences patient outcomes, necessitating careful consideration of pathogen resistance.
  • While other patient risk factors are important, optimizing antimicrobial therapy is a key modifiable factor for improving survival and reducing healthcare costs.
  • Further initiatives are needed to understand and combat the widespread impact of antimicrobial resistance on patients and healthcare systems.

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