Rodloff A C
Institut Medizinische Mikrobiologie und Infektionsepidemiologie, Universität Leipzig.
Langenbecks Arch Chir Suppl Kongressbd. 1997;114:953-5.
Strategies for selection of antimicrobial agents may include estimation of the most appropriate agent (empirical therapy), or planned escalation or de-escalation therapy. Severe and life-threatening infections such as peritonitis have a particularly poor prognosis if the initial therapy fails. Hence, in these cases a de-escalation therapy employing broad spectrum agents with proven high efficacy should be employed, and selection pressure arguments and cost considerations should be immaterial. After 48 to 72 hours, this initial therapy should be reconsidered (de-escalated to less powerful agents), especially in light of the microbiological test results.
抗菌药物的选择策略可能包括评估最合适的药物（经验性治疗），或计划性的升级或降阶梯治疗。如果初始治疗失败，像腹膜炎这样严重且危及生命的感染预后会特别差。因此，在这些情况下应采用使用已证实高效的广谱药物的降阶梯治疗，而选择压力因素和成本考量应无关紧要。48至72小时后，应重新考虑这种初始治疗（降级为效力较低的药物），尤其是根据微生物学检测结果。
