Antibiotic therapy of community respiratory tract infections: strategies for optimal outcomes and minimized resistance emergence

Abstract

Widespread, increasing antibiotic resistance amongst the major respiratory pathogens has compromised traditional therapy of the major infective respiratory syndromes, including bacterial pneumonia and acute exacerbations of chronic bronchitis. Guidelines for antibiotic prescribing dating from the 1980s to 1990s, which attempted to address such problems, were commonly too prescriptive and difficult to apply, and took little account of end-user practice or locally prevalent resistance levels. Further confusion was caused by conflicting recommendations emanating from differing specialty groups. The evidence that such guidelines benefited either clinical outcomes or treatment costs has been disputed. They have probably had little effect on resistance emergence. We report the recommendations of an independent, multi-national, inter-disciplinary group, which met to identify principles underlying prescribing and guideline formulation in an age of increasing bacterial resistance. Unnecessary prescribing was recognized as the major factor in influencing resistance and costs. Antibiotic therapy must be limited to syndromes in which bacterial infection is the predominant cause and should attempt maximal reduction in bacterial load, with the ultimate aim of bacterial eradication. It should be appropriate in type and context of local resistance prevalence, and optimal in dosage for the pathogen(s) involved. Prescribing should be based on pharmacodynamic principles that predict efficacy, bacterial eradication and prevention of resistance emergence. Pharmacoeconomic analyses confirm that bacteriologically more effective antibiotics can reduce overall management costs, particularly with respect to consequential morbidity and hospital admission. Application of these principles should positively benefit therapeutic outcomes, resistance avoidance and management costs and will more accurately guide antibiotic choices by both individuals and formulary/guideline committees.

Cost-effectiveness of point-of-care C-reactive protein testing to inform antibiotic prescribing decisions

“…26 Such benefit stems from its potential to contain antimicrobial resistance. [27][28][29][30] Antibiotic resistance is generally low in Nordic countries in comparison to other parts of Europe. 31 Prescribing in the Nordic countries is also lower than in most other parts of Europe.…”

Efficacy and safety of levofloxacin in the context of other contemporary fluoroquinolones: a review

“…4 Newer fluoroquinolones appear to be the drugs of the future for these indications, 4,5 at a time when standard therapy is increasingly compromised by bacterial drug resistance. 6 Many newer fluoroquinolones are available in IV and PO formulations, allowing flexibility in administration and offering the potential for IV-PO switch once the patient improves.…”

Ayaktan takip ve tedavi edilen erişkin hastalarda akılcı antibiyotik kullanımı

“…Özellikle viral infeksiyonlardan şüphelenilmesi halinde antibiyotiklerin her zaman gerekli olmadığı konusunda olguyu bilgilendirmek için zaman harcamak yerine klinisyenler, antibiyotik reçete edilmesini hastayı hızlı bir şekilde tedavi etme yolu olarak görebilmektedir. Ayrıca hekimler, bakteriyel infeksiyonu olan olgular için antibiyotik reçete etmemenin neden olacağı potansiyel sekellerden kaçınmak için savunmacı bir tıbbi yaklaşımla antibiyotik reçete edebilmektedirler [18,[20][21][22].…”