[Antibiotic policy in critical patients]

The combination of guidelines and strategies developed to improve and optimize the use of antimicrobials receives the name of antibiotic policy. Critical patients admitted to the Intensive Medicine Services have special characteristics (severity, pathogen agents, organ and/or system disorders) that justify the use of antibiotics differentially than for other hospitalized patients. The influence and impact of the antibiotics are observed in the patients who receive them (clinical response, course) and in the ecosystem surrounding the patient (hospital flora). This impact is especially visible in the critical patients in the endemic flora of the ICU. This article describes a combination of guidelines (guideline decalogue) and strategies (therapeutic de-escalation, cycling of antibiotics, preemptive treatment and pharmacokinetic/pharmacodynamic parameters) that have been applied and developed in the critical patients to optimize the use of the antimicrobials in order to achieve the maximum effectivity and minimum morbidity.