How to Design an Antibiotic Strategy That Respects the Indigenous Flora

Abstract

This chapter is meant to give practical guidelines on developing an antibiotic policy, bearing in mind the philosophy and goals [1] of selective decontamination of the digestive tract (SDD) as described in the earlier chapters of this book. These guidelines may be needed because SDD is meant to change the resident flora in such a way that secondary endogenous infections by that flora will not occur. As antibiotics given for (suspected) infection usually affect the resident flora, these antibiotics can easily interact in such a way as to conflict with the aims of SDD. Antibiotics can interact in several ways. They can inactivate the topical antibiotics used to achieve SDD, and they can also interact with the colonisation resistance. These guidelines will give some help in the choice of an antibiotic therapy that will allow both goals to be achieved: eliminating infection and persistence of colonisation resistance by unaffected gut flora with anaerobes and Gram-positive bacilli.