Optimizing Antimicrobial Chemotherapy in the ICU—A Review

  • Ian M. Gould


Infection is a common cause of admission to the ICU and is also commonly acquired on the ICU. Appropriate, early treatment improves outcome but choice of therapy is often empiric because of the delay in processing most microbiological specimens. This encourages the use of broad spectrum agents which leads to the selection of multiresistant bacteria, setting up a vicious circle of antibiotic use and resistance. The problem is enhanced by poor adherence to infection control procedures and the most intensive use of antibiotics anywhere in the hospital. Current resistant problems are greater than ever experienced and herald the dawn of untreatable infections. This comes during a period of reduced pharmaceutical company research on developing new agents. The author reviews the various strategies that can be employed to improve the quality of antibiotic prescribing in order to both improve patient outcome and reduce the selection of resistant strains. The use of the microbiological laboratory is explored in particular detail as are new pharmacodynamic concepts which guide dosing schedules. Particular attention is paid to combination therapy, stewardship strategies, and empiric treatment choices.


Minimum Inhibitory Concentration Methicillin Resistant Staphylococcus Aureus Empiric Therapy Antimicrobial Chemotherapy Acinetobacter Baumannii 


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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Ian M. Gould
    • 1
  1. 1.Department of Medical MicrobiologyAberdeen Royal InfirmaryAberdeenAustralia

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