Anti-Infective Therapy Time Recommended to complete: 3 days Frederick Southwick. M.D GUIDING QUESTIONS Are we at the end of the antibiotic era? 6. Does one antibiotic cure all infections? 2. Why are"superbugs"suddenly appearing in ou 7. What are the strategies that underlie optimal 3. How do bacteria become resistant to antibiotics? 8. How is colonization distinguished from infection 4. How can the continued selection of highly resis and why is this distinction important? tant organisms be prevented? 5. Is antibiotic treatment always the wisest course of action? Despite dire warnings that we are approaching the end of They use one or two broad-spectrum antibiotics to treat antibiotic era, the incidence of antibiotic-resistant all p acteria continues to rise. The proportions of penicillin Many excellent broad-spectrum antibiotics can resistant Streptococcus pneumoniae, hospital-acquired effectively treat most bacterial infections without requir rancomycin-resistant Enterococcus(VRE)strains continue empiric broad-spectrum antibiotics has resulted in the to increase. Community-acquired MRSA(cMRSA)is selection of highly resistant pathogens. A simplistic now common throughout the world. Multiresistant approach to anti-infective therapy and establishment of Acinetobacter and Pseudomonas are everyday realities in a fixed series of simple rules concerning the use of these Public of the existence of "diry ha w warning the lay agents is unwise and has proved harmful to patients fore, it is critical that health care providers understand bacteria, fungi, and viruses. It is no coincidence that the principles of proper anti-infective therapy and use these more primitive life forms have survived for nti-infective agents judiciously. These agents need to be millions of years, far longer than the human race. reserved for treatable infections-not used to calm the The rules for the use of anti-infective the atient or the patient's family. Too often, patients with dynamic and must take into account the ability of these viralieche physician's office expecting to be treated with the overuse of antibiotic, antifungal, and antiviral agents antibiotics to fulfill those expectation ust end, or more and more patients will become Physicians unschooled in the principles of microbiol- infected with multiresistant orga at cannot ogy utilize anti-infective agents just as they would more treated. Only through the judicious use of anti-infective conventional medications, such as anti-infammatory therapy can we hope to slow the arrival of the end of the agents, anti-hypertensive medications, and cardiac drugs. antibiotic era. Copyright 2007 by The McGraw-Hill Companies, Inc. Click here for terms of use.Despite dire warnings that we are approaching the end of the antibiotic era, the incidence of antibiotic-resistant bacteria continues to rise. The proportions of penicillin￾resistant Streptococcus pneumoniae, hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus (VRE) strains continue to increase. Community-acquired MRSA (cMRSA) is now common throughout the world. Multiresistant Acinetobacter and Pseudomonas are everyday realities in many of our hospitals. The press is now warning the lay public of the existence of “dirty hospitals.” As never before, it is critical that health care providers understand the principles of proper anti-infective therapy and use anti-infective agents judiciously. These agents need to be reserved for treatable infections—not used to calm the patient or the patient’s family. Too often, patients with viral infections that do not warrant anti-infective therapy arrive at the physician’s office expecting to be treated with an antibiotic. And health care workers too often prescribe antibiotics to fulfill those expectations. Physicians unschooled in the principles of microbiol￾ogy utilize anti-infective agents just as they would more conventional medications, such as anti-inflammatory agents, anti-hypertensive medications, and cardiac drugs. They use one or two broad-spectrum antibiotics to treat all patients with suspected infections. Many excellent broad-spectrum antibiotics can effectively treat most bacterial infections without requir￾ing a specific causative diagnosis. However, overuse of empiric broad-spectrum antibiotics has resulted in the selection of highly resistant pathogens. A simplistic approach to anti-infective therapy and establishment of a fixed series of simple rules concerning the use of these agents is unwise and has proved harmful to patients. Such an approach ignores the remarkable adaptability of bacteria, fungi, and viruses. It is no coincidence that these more primitive life forms have survived for millions of years, far longer than the human race. The rules for the use of anti-infective therapy are dynamic and must take into account the ability of these pathogens to adapt to the selective pressures exerted by the overuse of antibiotic, antifungal, and antiviral agents. The days of the “shotgun” approach to infectious diseases must end, or more and more patients will become infected with multiresistant organisms that cannot be treated. Only through the judicious use of anti-infective therapy can we hope to slow the arrival of the end of the antibiotic era. 1 Time Recommended to complete: 3 days Frederick Southwick, M.D. GUIDING QUESTIONS Anti-Infective Therapy 1 1. Are we at the end of the antibiotic era? 2. Why are “superbugs” suddenly appearing in our hospitals? 3. How do bacteria become resistant to antibiotics? 4. How can the continued selection of highly resis￾tant organisms be prevented? 5. Is antibiotic treatment always the wisest course of action? 6. Does one antibiotic cure all infections? 7. What are the strategies that underlie optimal antibiotic usage? 8. How is colonization distinguished from infection, and why is this distinction important? Copyright © 2007 by The McGraw-Hill Companies, Inc. Click here for terms of use