TY - JOUR
T1 - Broad-spectrum antimicrobials and the treatment of serious bacterial infections
T2 - Getting it right up front
AU - Kollef, Marin H.
N1 - Funding Information:
Potential conflicts of interest. M.H.K. is on the speakers’ bureau for Pfizer, Merck, Johnson & Johnson, and AstraZeneca; has received recent research funding from Pfizer and Bard Medical; has received grants from Merck, AstraZeneca, and Pfizer; and is a consultant to Bard Medical.
Funding Information:
Supplement sponsorship. This article was published as part of a supplement entitled “Update on the Appropriate Use of Meropenem for the Treatment of Serious Bacterial Infections,” sponsored by AstraZeneca LP.
PY - 2008/9/15
Y1 - 2008/9/15
N2 - The treatment of serious bacterial infections is complicated by the fact that time to initiation of effective antimicrobial therapy is a strong predictor of mortality. Therefore, therapy must be initiated before the causative pathogen is identified. However, inappropriate or inadequate initial empirical therapy is associated with increased mortality, morbidity, and length of hospital stay. Initial empirical therapy with broad-spectrum antimicrobials attempts to address this dilemma by "getting it right up front." The goal is to provide treatment active against the most likely pathogens until culture/susceptibility test results are obtained. After the causative pathogen is identified, streamlining to more-precise therapy of the shortest acceptable duration is implemented. In this way, the risks of death, morbid complications, increased duration of hospital stay (as a result of ineffective initial treatment), and emergence of resistance (due to extended treatment with broad-spectrum agents) are lowered. Improved clinical and economic outcomes after such an approach have been demonstrated.
AB - The treatment of serious bacterial infections is complicated by the fact that time to initiation of effective antimicrobial therapy is a strong predictor of mortality. Therefore, therapy must be initiated before the causative pathogen is identified. However, inappropriate or inadequate initial empirical therapy is associated with increased mortality, morbidity, and length of hospital stay. Initial empirical therapy with broad-spectrum antimicrobials attempts to address this dilemma by "getting it right up front." The goal is to provide treatment active against the most likely pathogens until culture/susceptibility test results are obtained. After the causative pathogen is identified, streamlining to more-precise therapy of the shortest acceptable duration is implemented. In this way, the risks of death, morbid complications, increased duration of hospital stay (as a result of ineffective initial treatment), and emergence of resistance (due to extended treatment with broad-spectrum agents) are lowered. Improved clinical and economic outcomes after such an approach have been demonstrated.
UR - http://www.scopus.com/inward/record.url?scp=51549114537&partnerID=8YFLogxK
U2 - 10.1086/590061
DO - 10.1086/590061
M3 - Review article
C2 - 18713047
AN - SCOPUS:51549114537
SN - 1058-4838
VL - 47
SP - S3-S13
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - SUPPL.1
ER -