Combination antimicrobial therapy

In spite of a large volume of data regarding the in vitro activity of single and combined antimicrobial activity, the clinical relevance of these studies is unclear. Few comparative trials of combined and single antibiotic therapy of human infection have been performed. Synergistic combination therapy has been shown to be beneficial in a few specific circumstances. Antagonistic combinations should be avoided in the treatment of meningitis, endocarditis, and infections of immunocompromised patients. The bactericidal titer of serum or spinal fluid should reflect adequacy of therapy of meningitis, endocarditis, and osteomyelitis, and adjustments can be made accordingly.