• Nishkantha Arulkumaran, Matthew Routledge, Sanmarié Schlebusch, Jeffrey Lipman, and Conway MorrisAndrewA0000-0002-3211-3216John V Farman Intensive Care Unit, Addenbrooke's Hospital, Cambridge, UK. ac926@cam.ac.uk.Division of Anaesthesia, Department of Medicine, University of Cambridge, Level 4, Addenbrooke's Hospital, Hills Road, Cambrid.
• Bloomsbury Institute for Intensive Care Medicine, University College, London, UK.
• Intensive Care Med. 2020 Feb 1; 46 (2): 225235225-235.

AbstractThe belief that, for the individual patient, the benefit of prompt and continued use of antimicrobials outweighs any potential harm is a significant barrier to improved stewardship of these vital agents. Antimicrobial stewardship may be perceived as utilitarian rationing, seeking to preserve the availability of effective antimicrobials by limiting the development of resistance in a manner which could conflict with the immediate treatment of the patient in need. This view does not account for the growing evidence of antimicrobial-associated harm to individual patients. This review sets out the evidence for antimicrobial-associated harm and how this should be balanced with the need for prompt and appropriate therapy in infection. It describes the mechanisms by which antimicrobials may harm patients including: mitochondrial toxicity; immune cell toxicity; adverse drug reactions; selection of resistant organisms within a given patient; and disruption of the microbiome. Finally, the article indicates how the harms of antimicrobials may be mitigated and identifies areas for research and development in this field.

20 keywords...

hide…