Antibacterial therapy. I. Some general considerations in regard to strategy
MARTIN C. MCHENRY, M.D.
Department of Internal Medicine, Section of Infectious Disease
THE rational and effective use of antibacterial drugs involves many considerations.1 All too often the drugs are administered indiscriminately or injudiciously, routinely rather than rationally, invariably rather than selectively, or hastily rather than with appropriate deliberation. Conversely, in patients with potentially curable infections, failures in therapy result all too frequently from incorrect choice of drugs, delay in initiation or from inadequate duration of therapy, improper dosage or route of administration, adverse reactions, and failure to correct underlying abnormalities that predispose to or complicate infection. This report concerns some general considerations in regard to selection and use of antibacterial drugs. The companion paper (II) discusses specific therapy of selected bacterial infections.
Objectives of therapy
A major objective of antibacterial therapy is the elimination of viable pathogens from diseased tissues in the shortest possible time with a minimum of adverse effects and inconvenience to the patient. Another purpose is prophylaxis—the prevention of implantation of specific bacteria in tissues. In order to achieve these objectives and to select antibacterial drugs rationally, the physician must have an understanding of their antibacterial spectrum, mechanisms of action, clinical pharmacology, therapeutic efficacy, and potential hazards. He must first of all have a knowledge of the location, etiology, severity, and natural history of the patient's infection, and of special circumstances that might influence the choice of antibacterial drugs and their method of administration.
Knowledge of the antibacterial spectrum of chemotherapeutic agents, the organisms responsible for infection and their in vitro susceptibility is essential for selection . . .