Cephalosporin therapeutics for intensive care infections.

Third generation cephalosporins are valuable agents in the ICU setting because of their broad spectrum of activity, in vitro potency against the Gram-negative bacilli commonly isolated in the ICU, and excellent penetration into most body sites. Multiresistant organisms may emerge as a result of widespread injudicious use of these agents, and this possibility is of special concern since these organisms may be associated with higher mortality rates. Combination therapy may be superior to monotherapy in severely ill patients with Gram-negative bacteremia. Double-beta lactam therapy has been efficacious in selected patients, although this regimen has several theoretical disadvantages. When third-generation cephalosporins are used for Gram-negative rod bacteremia in the ICU, combination therapy with an aminoglycoside should be considered.