The Rise of Irrational Antimicrobial Combinations: Need for Clinical Jurisprudence?

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Pharmacology

Background:

• Antimicrobial combinations are frequently used in critical care.
• The rationale for many combinations is often not evidence-based.
• Irrational use contributes to antimicrobial resistance and increased healthcare costs.

Purpose of the Study:

• To highlight the growing trend of irrational antimicrobial combinations.
• To emphasize the need for a structured approach, termed 'clinical jurisprudence', in selecting antimicrobial therapies.
• To advocate for evidence-based guidelines in antimicrobial prescribing.

Main Methods:

• Review of current prescribing practices.
• Analysis of literature supporting antimicrobial combinations.
• Discussion of the principles of clinical jurisprudence applied to antimicrobial therapy.

Main Results:

• A significant number of antimicrobial combinations are prescribed without clear clinical justification.
• Lack of robust clinical data supports the efficacy and safety of many empirical combinations.
• The rise in irrational combinations poses a threat to antimicrobial stewardship.

Conclusions:

• There is a critical need to establish clinical jurisprudence for antimicrobial combinations.
• Evidence-based decision-making should guide the selection of antimicrobial agents.
• Implementing stricter guidelines can improve patient outcomes and combat antimicrobial resistance.