New antibiotics: areas of appropriate use.

This has been an analysis of a number of agents whose clinical use has been approved in the past five years and of several agents that will undoubtedly be available within the next year. By the very nature of time alotted, the analysis had to be superficial. I believe that it is important to view all the agents because they cross each other in uses. I believe that areas of appropriate use exist for all of the compounds that I have discussed, and I also believe that cost and convenience will play increasingly important roles in the selection of what agent is most fitting, the definition of appropriate. In many infections it will not be possible to show a significant difference among drugs in a class, unless extremely large studies are undertaken. From my review of the literature in preparation for this meeting, I doubt these studies will be mounted. The infectious disease clinician must be familiar with all of the agents so that he or she can make judgments about which agent(s) make(s) the most sense for his/her hospital. I believe that it is fitting and proper for the infectious disease physician to appropriate the correct selection, methods of administration, and dose of antibiotic in many clinical situations, particularly ones in which parenteral agents are used. I hope the IDSA will have an impact on the proper use of the quinolones, monobactams, penems, and carbapenems. Our goal in the use of antimicrobial agents should be the selection of agents for prophylaxis, empiric therapy, and therapy for defined infections in a manner that results in cure, with reasonable cost and minimal damage to the microbial ecology.