When "S" does not mean success: the importance of choice of antibiotic and dose on clinical and economic outcomes of severe infection

Abstract

Antimicrobial resistance among bacterial pathogens continues to challenge clinicians. It is the main reason for antibiotic therapy to be deemed inappropriate and leads to unfavorable outcomes and increased costs. Knowledge of local susceptibility patterns can help clinicians empirically choose the appropriate antibiotic. In addition, the proper dosage regimen, based on pharmacodynamics, is essential to maximize the likelihood of achieving optimal therapy. Pharmacodynamic surveillance studies have demonstrated that percent susceptibility provides an accurate estimate of bactericidal exposure at standard dosage regimens for carbapenems, ceftazidime, and cefepime, whereas percent susceptibility overestimates actual bactericidal exposure for piperacillin/tazobactam and ciprofloxacin. The empiric use of appropriate broad-spectrum antimicrobial therapy at the correct dosages for severe infections should improve clinical outcomes and result in economic benefit. Initial therapy should have a high likelihood of covering resistant pathogens.