Antibiotic Therapy of Surgical Infections (Current Practice) (Report‪)‬

We face a crisis with regard to antibiotic resistance. Highly pathogenic, pan-resistant Gram-negative (GN) or highly resistant Gram-positive (GP) infections are increasingly prevalent in the intensive care unit and in the general wards. Whereas no intervention will eradicate resistance, it is essential that antibiotic management be optimised both to improve efficacy and to extend the lifespan of drugs that are currently available. (1) Therapy of severe community-acquired (CA) infections (those with organ dysfunction and/or hypotension) are treated according to the site, local resistance patterns, the presence or absence of factors associated with resistance, and the pharmacokinetics and pharmacodynamics of the specific drug and its ability to penetrate into the infected tissue. Whatever the type of infection, the principles of antibiotic therapy remain the same. Therapy should be initiated as soon as possible via the parenteral route, (2) and 5-7 days is the recommended duration. (3,4) Therapy should be directed towards clinical response, which limits duration--prolonged duration of antibiotic treatment and overuse of antibiotics being the most important factors causing resistance. If features of sepsis persist after 2-3 days, the first consideration should be that there has been inadequate source control rather than that the infection is resistant or that a prolonged course of antibiotics is required. (5)