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The Problem of Selecting Antimicrobial Agents Before (or Without) the Results of Susceptibility Testing

Published online by Cambridge University Press:  21 June 2016

Charles W. Stratton
Charles W. Stratton*
Affiliation:
Department of Pathology, Vanderbilt University School of Medicine, Nashville, Tennessee
*
Vanderbilt University School of Medicine, Nashville, TN 37232
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Extract

A recent article in this section reviewed some problem areas of susceptibility testing. In particular, the “myth” of susceptibility testing being predictive of clinical outcome was discussed. The realization of this myth often leaves clinicians less comfortable when selecting antimicrobial agents. The question they often ask is, “How does one select antibiotics?” This question has always been important for empiric therapy of the septic patient. It has become even more important in the cost containment era. The introduction of new antimicrobial agents that are very costly when compared with older agents has greatly complicated antimicrobial therapy. It is now possible to use antibiotics correctly in a therapeutic sense, but to misuse them in an economic sense. Nonetheless, recognition of new pathogens, increasing resistance of pathogens to older antimicrobial agents and more complicated clinical problems have increased the need for these new agents. The following discussion will focus on those factors upon which the selection of a specific antimicrobial agent (or combination of agents) is based, the least of which should be the results of susceptibility tests.

Type
Special Sections
Information
Infection Control & Hospital Epidemiology , Volume 9 , Issue 12 , December 1988 , pp. 559 - 561
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1988

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References

1. Stratton, CW: Susceptibility testing today: Myth, reality, and new direction. Infect Control Hosp Epidemiol 1988; 9:264–267.CrossRefGoogle ScholarPubMed
2. Inglehart, JK: The new era of prospective payment for hospitals. N Engl J Med 1983; 308:226.Google Scholar
3. Maug, TH 11: A new wave of antibiotics builds. Science 1981; 214:1125–1128.Google Scholar
4. Neu, HC: Antimicrobial activity, bacterial resistance and antimicrobial pharmacology: Is it possible to use new agents cost effectively? Am J Med 1985; 78(suppl 6B):17–22.CrossRefGoogle ScholarPubMed
5. Yu, VL, Kroboth, FJ, Brown, A, et al: Legionnaire's disease: A new clinical perspective from a prospective pneumonia study. Am J Med 1982; 73:357–361.CrossRefGoogle ScholarPubMed
6. Haley, RN, Hightower, AW, Khabbas, RF, et al: Emergence of methicillin-resistant Staphylococcus aureus infections in the United States hospitals. Ann Intern Mud 1982; 97:297–308.CrossRefGoogle ScholarPubMed
7. Thomalla, JV, Thompson, S, Rowland, R, et al: Inftctious complications of penile prosthetic implants. J Urol 1987. pp 63–67.Google Scholar
8. Lau, WY, Fan, ST. Chu, KW, et al: Randomized, prospective, and double-blind trial of new β-lactams in the treatment of appendicitis. Antimicroh Agents Chemother 1985: 28:639–642.CrossRefGoogle ScholarPubMed
9. Chalkley, LJ, Koornhof, HJ: Antimicrobial activity of ciprofloxacin against Pseudomonas aeruginosa, Escherichia coli, and Staphylococcus aureus determined the kilhng curve method: Antibiotic comparisons and synergistic interactions. Antimicroh Agents Chemother 1985; 28:331–342.CrossRefGoogle ScholarPubMed
10. Moore, RD. Lietman, PS, Smith, CR: Clinical response to aminoglycoside therapy: Importance of the ratio of peak concentration to minimal inhibitory concentration. J Infect Dis 1987; 155:93–99.CrossRefGoogle ScholarPubMed
11. Kapusnik, JE, Harkbarth, CJ, Chambers, HF, et al: Single large, daily dosing versus intermittent dosing of tobramycin for treating experimental Pseudomonas pneumonia. Infect Dis 1988; 158:7–12.CrossRefGoogle ScholarPubMed
12. Hobby, GL, Meyer, K, Chaffee, E: Observations on the mechanism of action of penicillin. ProcSoc Exp Biol Med 1942; 50:281–285.CrossRefGoogle Scholar
13. Eagle, H, Mussleman, AD: The rate of bacterial action of penicillin in vitro as a function of its concentration and its paradoxically reduced activity at high concentrations against certain organisms. J Exp Med 1948; 88:99–131.CrossRefGoogle ScholarPubMed
14. Barriere, SL, Kapusnik, JE, Ely, E. et al: Analysis of a new method to detect antibacterial synergy: Area under the bactericidal titer curve. J Antimicroh Chemother 1985; 16:49–60.CrossRefGoogle Scholar
15. Murray, PR, O'Brvne, A: Cost of antibiotic therapy. N Engl J Med 1983: 308:226.Google Scholar