Longnecker's Anesthesiology > Part 2. Preparing for Anesthesia > Section B. Preoperative Evaluation of the Anesthesia Patient > Chapter 17. Principles of Antimicrobial Therapy Richard Teplick, MD, and Robert H. Rubin, MD, FACP, FCCP

Principles of Antimicrobial Therapy: Introduction

"In general, antimicrobials may be used in three different modes: therapeutic, prophylactic, and preemptive. In the therapeutic mode, they are prescribed to treat established clinical infection. The appropriate therapeutic use of antimicrobial drugs requires the prompt diagnosis of clinical infection and a clear understanding of the pharmacologic principles governing treatment of such infections. In the prophylactic mode, antimicrobials are prescribed to all members of a given population prior to an event, for example, an operation, to prevent infection. Successful prophylactic programs require that the antimicrobial therapy be sufficiently nontoxic, inexpensive, and efficacious to justify the intervention. Finally, in the preemptive mode, antimicrobial therapy is administered to the subgroup of individuals based on either laboratory markers or clinical epidemiologic characteristics that place them at significant risk of a serious clinical infection. Effective preemptive therapy requires the careful delineation of the factors that justify antimicrobial intervention at a point when clinical disease is not yet manifest.^1,2 This chapter presents the pharmacologic and clinical principles that underlie all three forms of antimicrobial use, distinguishing between that which is known and that which needs further study. Reviews of specific antibiotics can be found in a series published in the Mayo Clinics Proceedings.^3–12 Information on newer antibiotics, such as cyclic lipopeptides, glycylcyclines, ketolides, oxazolidinones, streptogramins, and newer fluoroquinolones..."