Antibiotic Guidelines : Pharmacological Parameters to be Considered

The aim of antibiotic guidelines is to provide guidance on the rational use of antibiotics, so that they serve effectively and eficiently with the least adverse effects on patients and co,n,tturtity. Tlrc iupact of such strategy nny also be seen in the containtnent of cost without ieopardizing the patient to un-successful atteupts of antibiotic treatnent. Guidelines have to satisfy certain requiretnents in order to be accepted by its users. It should workfor the majority (approx.go%) of patient groups and the antibiotic selectiorx suggested should be effective without or before the results ofantibiograns. Antibiotic guidelines nust be based on nicrobiological, phannacological and clinical knowledge. Among phannacological paranteters of the antibiotic that will be discussed are pharmacodynanics, pharmacokinetics, toxicity and adverse effects, results of clinical trials and drug-epideniological studies, and the conparative phannacology of antibiotics. The main strategy for selection is based on benefit-risk-cost csscssrlent; the presu,ned benefit that the antibiotic could offer for a certain indication should be greater that the possible risks it conld give rise to. The principle of treatnent: "Pritnum non nocere" should always be a prior consideration. In this respect the great potential of antibiotics to cause adversity is very often overlooked, causing the erroneous attitude of "if it does not work, it does not harn either". Guidelines.are neyeruneant to be rigid rules; scientific judgetnent should always be the final guide, especially in complicated clinical conditions. Renewal of choices of antibiotics should be instituted whenever recent infonnation is available and updating of an antibiotic guideline is nandatory every year or two. Usually there are no sanctions for violating good advice, but najor deviations frotn guidelines nust be scientifically justifiable.