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Principles of selecting appropriate antimicrobial agents

Article information

J Korean Med Assoc. 2019;62(6):335-344
Publication date (electronic) : 2019 June 14
doi : https://doi.org/10.5124/jkma.2019.62.6.335
Su-Mi Choi, MD1orcid_icon, Dong-Gun Lee, MD1,2orcid_icon
1Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
2Vaccine Bio-Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Corresponding author: Dong-Gun Lee. symonlee@catholic.ac.kr
Received 2019 April 12; Accepted 2019 May 14.

Abstract

The inappropriate use of antimicrobial agents results in collateral damages such as treatment failure, an increased frequency of adverse events related to antimicrobial agents, the emergence of resistant bacteria, and increased medical costs. The selection of appropriate antimicrobial agents begins with taking a detailed history and performing a thorough physical examination to determine whether the cause of the fever is infectious or non-infectious. Based on the patient's symptoms and signs, the site of infection (a system-oriented approach) and the causative organism with high possibility (a pathogenesis-oriented approach: intracellular vs. extracellular) can be estimated. In this process, host factors, microbial factors, and the characteristics of antimicrobial agents should be considered. Herein, we summarize the recently developed Korean guidelines for the use of antimicrobial agents for infectious diseases. We also introduce the antimicrobial website and application developed by Korean Society for Antimicrobial Therapy and the antimicrobial stewardship program.

Keywords: Anti-infective agents; Antimicrobial stewardship; Practice guideline

Notes

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

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Figure 1

Figure 1

Approaches to febrile patients (A) and general considerations in selecting appropriate antimicrobial agents (B). G (+), gram-positive organisms; G (−), gram-negative organisms; PK/PD, pharmacokinetics/pharmacodynamics; TDM, therapeutic drug monitoring.

Table 1

Organ/system-oriented approach for infectious diseases and its suggestive symptoms and signs

Table 1

Table 2

Recently developed guidelines for antimicrobial agent use in Korea

Table 2

Table 3

Core elements of hospital antibiotic stewardship program

Table 3

Adapted from Pollack LA, et al. Clin Infect Dis 2014;59 Suppl 3:S97-S100 [28].