[Antibiotic stewardship - recent developments]

Area of Science:

• Pharmacology
• Infectious Diseases
• Clinical Pharmacy

Background:

• Recent trends indicate a decrease in fluoroquinolone and cephalosporin use in German healthcare settings.
• Penicillin derivatives are increasingly favored, and aminoglycosides are being reconsidered for specific infections.
• Limited updates exist on antibiotic strategies for hematology-oncology patients, particularly concerning fever and neutropenia.

Purpose of the Study:

• To review current trends in antibiotic prescribing in Germany.
• To evaluate the re-emergence of aminoglycosides as therapeutic options.
• To discuss rational antibiotic use in hematology-oncology, including empirical and targeted therapies.

Main Methods:

• Analysis of antibiotic consumption data in hospital and outpatient settings.
• Review of current clinical guidelines and evidence for antibiotic use in specific patient populations.
• Discussion of antibiotic resistance patterns and therapeutic alternatives.

Main Results:

• Decreased prescription rates for fluoroquinolones and cephalosporins, with a rise in penicillin derivative use.
• Aminoglycosides show renewed utility for urinary tract infections and potentially sepsis due to favorable activity and low resistance.
• For fever and neutropenia in hematology-oncology, piperacillin-tazobactam or carbapenems remain first-line, with extended infusions recommended. Linezolid is a reserve drug.
• Careful patient history can identify subgroups suitable for re-exposure to penicillins despite alleged allergies.

Conclusions:

• Antibiotic prescribing patterns are evolving, necessitating updated therapeutic strategies.
• Aminoglycosides offer a valuable alternative in specific clinical scenarios.
• Evidence-based guidelines are crucial for optimizing antibiotic use, especially in immunocompromised patients.
• Accurate allergy assessment can safely expand penicillin use.