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Antimicrobial agents: the old and the new
1College of Physicians & Surgeons, Columbia University, New York, NY 10032.
Abstract:
Although there are many new antimicrobial agents, many of the old antibiotics are still useful in the treatment of infections, particularly those in the community. Antimicrobial resistance patterns and special pharmacologic properties should influence the selection of newer antimicrobial agents. Change from parenteral therapy to oral therapy should increase to avoid the complications of intravenous therapy and to reduce hospital costs. Older antibiotics that are less costly should be used when the etiology and susceptibility of infecting pathogens are known. There will continue to be new antibiotics produced. Understanding the microbiologic and pharmacologic advantages of the new agents compared with older agents is essential if the new agents are to be used properly and not destroyed by inappropriate use.
Insights
Older antibiotics remain valuable for community infections, especially when pathogen susceptibility is known. Judicious selection of new antimicrobial agents, considering resistance patterns and pharmacologic properties, is crucial for effective treatment and preventing resistance.
Area of Science:
- Microbiology
- Pharmacology
- Infectious Diseases
Background:
- Despite the development of novel antimicrobial agents, established antibiotics continue to play a significant role in treating infections, particularly in community settings.
- Antimicrobial resistance patterns and specific pharmacological characteristics are critical factors in selecting appropriate antimicrobial therapies.
- Transitioning from parenteral to oral antimicrobial therapy can mitigate complications associated with intravenous administration and reduce healthcare costs.
Purpose of the Study:
- To emphasize the continued utility of older antibiotics in specific clinical scenarios.
- To highlight the importance of considering antimicrobial resistance and pharmacologic properties in agent selection.
- To advocate for a strategic approach to antimicrobial therapy, balancing the use of older and newer agents.
Main Methods:
- This review synthesizes current knowledge on antimicrobial agent selection.
- It analyzes the role of antimicrobial resistance patterns and pharmacologic properties in therapeutic decisions.
- The study evaluates the benefits of switching from parenteral to oral antimicrobial therapy.
Main Results:
- Older antibiotics are cost-effective and effective when the causative pathogen and its susceptibility profile are known.
- Newer antimicrobial agents offer distinct advantages but require careful consideration of their microbiologic and pharmacologic profiles.
- A shift towards oral therapy can decrease complications and lower hospital expenses.
Conclusions:
- Older antibiotics remain essential tools in infectious disease management, particularly for community-acquired infections.
- Informed selection of both new and old antimicrobial agents, based on resistance data and pharmacologic properties, is vital.
- Appropriate use of antimicrobial agents is paramount to preserve their efficacy and combat resistance.