antibioticsbooks

44 PART 1 Antibiotic Therapy
uses, the greater the antibiotic resistance). The
development of antibiotic resistance leads to a
vicious spiral where resistance necessitates the
development of broader-spectrum antibiotics,
leading to evolution of bacteria resistant to those
new antibiotics, requiring ever broader-spectrum
drugs, and so on. This is particularly problematic
because antibiotic development has slowed
down greatly. Although we can see clearly the
broad relationship between antibiotic use and
resistance, many of the details of this relationship
are not clear. Why do some bacteria develop
resistance rapidly and others never develop resistance?
What is the proper duration of treatment
to maximize the chance of cure and minimize the
risk of resistance?
Guidelines
Until we develop a more sophisticated understanding
of the relationship between antibiotic use and
resistance on a micro level, we are left with some
general guidelines for minimizing the potential for
development of resistance.
Avoid Using Antibiotics to Treat Colonization or
Contamination
A substantial percentage of all antibiotic use is
directed toward patients who are not truly infected,
but in whom organisms are recovered from culture.
Isolation of Staphylococcus epidermidis from a
single blood culture or Candida species from a urinary
culture in a catheterized patient are common
situations in which patients should be scrutinized
to determine whether an infection is truly present.
A proper diagnosis is key.