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Antibiotic combinations: should they be tested?

G M Eliopoulos1, C T Eliopoulos

  • 1Department of Medicine, New England Deaconess Hospital, Boston, Massachusetts 02215.

Clinical Microbiology Reviews
|April 1, 1988
PubMed
Summary

In vitro testing of antibiotic combinations is rarely needed, but can be useful for synergy. This review examines mechanisms, animal models, and clinical data on synergistic antibiotic interactions in human infections.

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Area of Science:

  • Microbiology
  • Pharmacology
  • Infectious Diseases

Background:

  • Antibiotic combinations broaden spectrum and prevent resistance.
  • In vitro synergy testing is not always practical.
  • Screening methods can substitute formal synergy testing.

Purpose of the Study:

  • Examine mechanisms of antibiotic interaction (synergism/antagonism).
  • Correlate in vitro observations with animal model efficacy.
  • Review clinical data on synergistic antibiotic interactions in human infections.

Main Methods:

  • Literature review of antibiotic interaction mechanisms.
  • Survey of studies correlating in vitro data with animal models.
  • Review of clinical trials and case studies on combination therapy.

Main Results:

  • Antibiotic interactions can be synergistic or antagonistic.
  • Correlation between in vitro synergy and in vivo efficacy varies.
  • Clinical evidence for the utility of synergistic antibiotic interactions is mixed.

Conclusions:

  • In vitro synergy testing is most valuable when specific synergistic interactions are sought.
  • Animal models provide some correlation but do not fully predict clinical outcomes.
  • Further research is needed to clarify the clinical role of synergistic antibiotic combinations in treating infections.

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