British journal of hospital medicine
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With infection rates approaching 80% for patients staying in ICU for more than 5 days there is clearly a need for effective prophylaxis. SPEAR is a system of antimicrobial prophylaxis which extends the regimen of selective digestive tract decontamination to encompass systemic antimicrobial prophylaxis and includes oral non-absorbable antibacterial and antifungal agents with initial use of a broad-spectrum systemic antibacterial.