Principles of Judicious Antimicrobial

Because of the increase in resistance it is increasingly important that recommendations for judicious use of antibiotics for RTI be reviewed. Several organizations have published guidelines for appropriate antimicrobial usage (23-26). When recommendations from such guidelines are applied to select an appropriate empiric agent, the clinical outcome is hopefully optimized and the costs associated with incorrect prescribing and multiple courses of antibiotics can be avoided. Principles of optimized therapy should be promoted and utilized by prescribing clinicians in order to result in the best outcomes for our patients and reduce the emergence of antibiotic resistance. This is the conclusion of a consensus group on resistance and prescribing in RTI. This independent, multinational, interdisciplinary group was established to identify fundamental principles that should form the basis of prescribing in RTI and guideline formulation, with particular emphasis on countering bacterial resistance and maximizing beneficial patient outcomes (27).

The Consensus Group listed several core principles of antibiotic therapy that should provide optimal benefit for patients as well as minimize resistance; among these are:

  1. Use antibacterial therapy only in those patients with bacterial infection.
  2. Utilize diagnostic and other measures to reduce prescribing. Therapy should maximally reduce or eradicate the bacterial load.
  3. Use antimicrobial agents with optimal pharmacodynamics to achieve eradication.
  4. Use locally relevant resistance data in the decision process.
  5. Understand that antimicrobial acquisition cost may be insignificant compared with therapeutic failure.
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