From the Guidelines
Rational use of antibacterial drugs requires careful selection of appropriate medications based on the suspected pathogen, infection site, patient factors, and local resistance patterns, as emphasized by the American College of Physicians in 2021 1.
Key Principles
- Clinicians should first determine if antibiotics are truly necessary, as viral infections do not respond to antibacterial therapy.
- When antibiotics are indicated, narrow-spectrum agents should be used whenever possible to minimize disruption of normal flora and reduce selection pressure for resistant organisms.
- Therapy duration should be the shortest effective course, with many infections now requiring shorter regimens than traditionally prescribed.
Patient Assessment
- Clinicians should obtain appropriate cultures before starting antibiotics in serious infections to allow for targeted therapy once results return.
- Dosing must be adjusted for patient weight, renal function, and hepatic function to ensure adequate drug levels while minimizing toxicity.
Treatment Approach
- Regular reassessment of therapy at 48-72 hours is essential to determine if antibiotics can be de-escalated, narrowed, or discontinued based on clinical response and culture results.
- For community-acquired intra-abdominal infections (CA-IAIs), agents with a narrower spectrum of activity are preferred, while for healthcare-associated infections (HA-IAIs), antibiotic regimens with broader spectra of activity are preferred 1.
Antibiotic Selection
- The choice of empiric antibiotic regimens in patients with intra-abdominal infections should be based on the clinical condition of the patients, the individual risk for infection by resistant pathogens, and the local resistance epidemiology 1.
- Beta-lactam/beta-lactamase inhibitor combinations, such as piperacillin/tazobactam, have an in vitro activity against gram-positive, gram-negative, and anaerobe organisms, making them an option for management of severe IAIs.
Resistance Considerations
- The use of carbapenems should be limited to preserve activity of this class of antibiotics due to the concern of emerging carbapenem-resistance 1.
- New antibiotics, such as ceftolozone/tazobactam and ceftazidime/avibactam, have been approved for treatment of complicated IAIs, including infection by ESBLs producing Enterobacteriaceae and P. aeruginosa, and will be valuable for treating infections caused by MDR gram-negative bacteria.
From the FDA Drug Label
Patients should be counseled that antibacterial drugs, including amoxicillin and clavulanate potassium tablets, should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold). When amoxicillin and clavulanate potassium tablets are prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may: (1) decrease the effectiveness of the immediate treatment, and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by amoxicillin and clavulanate potassium tablets or other antibacterial drugs in the future
The rational use of antibacterial (antibiotics) drugs is to only use them to treat bacterial infections, and to take the medication exactly as directed to prevent decreasing the effectiveness of the treatment and increasing the likelihood of bacterial resistance 2.
- Key points:
- Only use antibacterial drugs for bacterial infections
- Do not use antibacterial drugs for viral infections
- Take the medication exactly as directed
- Complete the full course of therapy to prevent bacterial resistance
From the Research
Rational Use of Antibacterial Drugs
The rational use of antibacterial drugs, also known as antibiotics, is crucial to effectively treat bacterial infections while minimizing the risk of adverse effects and the development of resistance 3, 4, 5, 6, 7.
Importance of Rational Use
- Reduces the burden of patients
- Reduces adverse drug reactions
- Effectively cures bacterial infections 4
- Helps shorten treatment time
- Reduces drug-resistant bacteria 5
Factors to Consider
- Local susceptibility patterns
- Clinical experience
- Site of infection
- Potential toxicities
- Cost 3
- Patient's individual pharmacokinetic alterations
- Pharmacodynamic properties of the drug 7
Guidelines for Rational Use
- Develop a reasonable and scientific list of antimicrobial drugs
- Standard training for correct use of antimicrobial drugs 4
- Pharmacy management departments should supervise the use of antimicrobial agents
- Consider the use of combination antimicrobial therapy for certain infections 3