The new treatment paradigm and the role of carbapenems

The global increase in antibiotic resistance is promoted by the widespread use of broad-spectrum antibiotics, creating a continuous selective pressure on bacteria. This resistance is depleting the number of effective antimicrobial agents. Since there have been few new agents active against Gram-negative bacteria in particular developed over the last two decades, it is important to make the most of existing antibiotics. Therefore, rational use of antimicrobial agents is vital in establishing a successful strategy to control and prevent both the clinical impact and the development of further resistance. Careful selection of the appropriate antimicrobial agent combined with correct dosing, duration of treatment and route of administration are all important to the success of this strategy and need to be coupled with antimicrobial resistance surveillance. Progress against the treatment strategy approach for optimising clinical outcomes whilst preventing antibacterial resistance based on antibiotic de-escalation will be reviewed with particular emphasis on the role of the carbapenems. This approach attempts to balance the need to provide appropriate initial treatment whilst limiting the emergence of antibacterial resistance. (C) 2008 Elsevier B. V. and the International Society of Chemotherapy. All rights reserved.