Klugman Keith P
Department of International Health, Rollins School of Public Health, Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA 30322, USA.
Int J Infect Dis. 2003 Mar;7 Suppl 1:S27-31. doi: 10.1016/s1201-9712(03)90068-3.
Antimicrobial prescribing in respiratory tract infection is generally empirical. Agents that do not eradicate the key bacterial respiratory pathogens (Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis) provide suboptimal therapy. A recent paper developed by a multidisciplinary, multinational group presented a consensus on the principles that should underpin appropriate antimicrobial prescribing. In summary, in order to ensure clinical success and minimize the threat of resistance, empirical therapy should avoid unnecessary and inappropriate use of antimicrobials, deliver the right agent at the right dose and duration, and rapidly eradicate the pathogen at the site of infection. Accurate diagnosis is essential to ensure that only bacterial infections are treated with antibacterial agents. The application of pharmacokinetic/pharmacodynamic (PK/PD) principles to both new and existing antimicrobials allows the prediction of bacteriologic efficacy. Applying these principles when prescribing therapy can help in reducing the potential for the selection and spread of resistance. Local resistance patterns and the bacteriologic/clinical impact of resistance should also be considered. The use of antimicrobials with optimal PK/PD characteristics may be more cost-effective than allowing the possibility of resistance-induced failure. Changing prescribing habits without taking all these factors into account may increase the incidence of unfavorable patient outcomes and the cost of treatment, with more referrals and hospitalizations. Changes in prescribing habits should be considered carefully, to avoid unintended negative consequences. It is the responsibility of physicians to ensure that each prescription is necessary and will maximize the potential for clinical cure, but there is also a collective responsibility to sustain the diversity of antimicrobial therapy via appropriate formularies, guidelines and licensing, reduced over-the-counter availability, and continued research and development through academia and industry. To maximize clinical cure and minimize the emergence and spread of resistance, antimicrobial prescribing should maximize bacterial eradication, and clinical drug evaluation needs to be brought into line with this need.
呼吸道感染的抗菌药物处方通常是经验性的。不能根除关键呼吸道细菌病原体（肺炎链球菌、流感嗜血杆菌和卡他莫拉菌）的药物提供的治疗效果欠佳。一个多学科、跨国团队近期发表的一篇论文就合理抗菌药物处方应遵循的原则达成了共识。总之，为确保临床成功并将耐药威胁降至最低，经验性治疗应避免不必要和不恰当使用抗菌药物，以正确的剂量和疗程给予合适的药物，并在感染部位迅速根除病原体。准确诊断对于确保仅用抗菌药物治疗细菌感染至关重要。将药代动力学/药效学（PK/PD）原则应用于新的和现有的抗菌药物可预测细菌学疗效。在开处方时应用这些原则有助于降低耐药性选择和传播的可能性。还应考虑当地的耐药模式以及耐药性对细菌学/临床的影响。使用具有最佳PK/PD特性的抗菌药物可能比任由耐药导致治疗失败更具成本效益。在未考虑所有这些因素的情况下改变处方习惯可能会增加不良患者结局的发生率和治疗成本，导致更多的转诊和住院。应谨慎考虑改变处方习惯，以避免意外的负面后果。确保每张处方都是必要的并将临床治愈的可能性最大化是医生的责任，但通过适当的处方集、指南和许可、减少非处方可得性以及学术界和产业界持续的研发来维持抗菌治疗的多样性也有集体责任。为了最大化临床治愈并最小化耐药性的出现和传播，抗菌药物处方应最大化细菌根除，并且临床药物评估需要与此需求保持一致。
