Optimizing Antimicrobial Therapy of Sepsis and Septic Shock

Preface
Optimizing Antimicrobial
T h e r a p y of S e p s i s a n d S e p t i c
Shock

Anand Kumar, MD
Guest Editor

Since the advent of modern antimicrobial therapy with the introduction of penicillin
over 50 years ago, the focus of the pharmaceutical scientists and clinicians has
primarily been on the development of ever more potent and broad spectrum agents
to counter the inevitable and inexorable expansion of antimicrobial resistance. In
that regard, pharmaceutical science has been tremendously successful with dozens
of classes of antimicrobials and hundreds of individual agents now available around
the globe. Yet, the problem of resistance has continued unabated to the point that
some pathogens appear impervious to virtually every known antimicrobial.
New antimicrobial agents in the pipeline have slowed dramatically. While this may be
a serious concern if sustained in the long term, in the short term it provides an impetus for
alternative approaches. Among these are learning how to use the antimicrobials we
already have in a more effective manner. This issue of Critical Care Clinics is dedicated
to that question. Rather than focusing on the newest drugs in development, the articles
in this collection are dedicated to addressing the issue of how we can use the drugs that
we already have in a fashion that maximizes their effectiveness. Although this question is
always of importance, critically patients, particularly those with septic shock, represent
the group in which optimal antimicrobial therapy may have the greatest impact. Fundamentally, optimization of antimicrobial therapy (whether choosing a microbiologically
appropriate drug, using a multi-drug strategy for a single pathogen, optimizing pharmacokinetic/pharmacodynamic indices, using a cidal rather than a static agent, or simply
using larger doses) primarily involves more rapid elimination of the pathogen. Infections
where an antimicrobial therapy delay-dependent risk of irreversible and irreplaceable
organ failure exists (such as bacterial meningitis and septic shock) are the conditions
most likely to show a clear benefit.

Crit Care Clin 27 (2011) xiexii

doi:10.1016/j.ccc.2010.11.007
criticalcare.theclinics.com
0749-0704/11/$ e see front matter 2011 Elsevier Inc. All rights reserved.

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Preface

Although not well known, the initial use of penicillin involved continuous infusion.
Convenience combined with the exceptional efficacy of the compound drove the transition to intermittent dosing regimens without significant evidence of superior effect. In
these times of increasing antimicrobial resistance, perhaps a rigorous re-evaluation of
our clinical approach to antimicrobial administration in life-threatening infections can
fill in the gap pending development of novel drugs, while resulting in improved
outcomes for our patients.
Anand Kumar, MD
Section of Critical Care Medicine
Section of Infectious Diseases
Medical Microbiology and Pharmacology/Therapeutics
University of Manitoba Health Sciences Centre
JJ 399 700 William Avenue, Winnipeg
Manitoba R3E-0Z3, Canada
Robert Wood Johnson Medical School
University of Medicine and Dentistry
Camden, NJ, USA
E-mail address:
akumar61@yahoo.com

DEDICATION

For my wife, Aparna