Journal List > J Korean Med Assoc > v.62(6) > 1126805

Choi and Lee: Principles of selecting appropriate antimicrobial agents

Abstract

The inappropriate use of antimicrobial agents results in collateral damages such as treatment failure, an increased frequency of adverse events related to antimicrobial agents, the emergence of resistant bacteria, and increased medical costs. The selection of appropriate antimicrobial agents begins with taking a detailed history and performing a thorough physical examination to determine whether the cause of the fever is infectious or non-infectious. Based on the patient's symptoms and signs, the site of infection (a system-oriented approach) and the causative organism with high possibility (a pathogenesis-oriented approach: intracellular vs. extracellular) can be estimated. In this process, host factors, microbial factors, and the characteristics of antimicrobial agents should be considered. Herein, we summarize the recently developed Korean guidelines for the use of antimicrobial agents for infectious diseases. We also introduce the antimicrobial website and application developed by Korean Society for Antimicrobial Therapy and the antimicrobial stewardship program.

Figures and Tables

Figure 1

Approaches to febrile patients (A) and general considerations in selecting appropriate antimicrobial agents (B). G (+), gram-positive organisms; G (−), gram-negative organisms; PK/PD, pharmacokinetics/pharmacodynamics; TDM, therapeutic drug monitoring.

jkma-62-335-g001
Table 1

Organ/system-oriented approach for infectious diseases and its suggestive symptoms and signs

jkma-62-335-i001
Table 2

Recently developed guidelines for antimicrobial agent use in Korea

jkma-62-335-i002
Table 3

Core elements of hospital antibiotic stewardship program

jkma-62-335-i003

Adapted from Pollack LA, et al. Clin Infect Dis 2014;59 Suppl 3:S97-S100 [28].

Notes

Conflict of Interest No potential conflict of interest relevant to this article was reported.

References

1. Pillai SK, Eliopoulos GM, Moellering RC. Principles of anti-infective therapy. In : Mandell GL, Douglas RG, Bennett JE, Dolin R, Blaser MJ, editors. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia: Churchill Livingstone Elsevier;2015. p. 224–234.
2. Oh MD, Choe KW. General principles of antibiotics use. The Korean Society of Infectious Diseases. Textbook of guidepost to antimicrobial. 4th ed. Seoul: Koonja;2016. p. 53–66.
3. Yoo JH. The Infinity war: how to cope with carbapenem-resistant Enterobacteriaceae. J Korean Med Sci. 2018; 33:e255.
crossref
4. Surana NK, Kasper DL. Approach to the patient with an infectious disease. In : Jameson JL, editor. Harrison's principles of internal medicine. New York: McGraw Hill;2018. p. 859–866.
5. Barlam TF, Kasper DL. Approach to the acutely ill infected febrile patient. In : Jameson JL, editor. Harrison's principles of internal medicine. New York: McGraw Hill;2018. p. 877–884.
6. Hessen MT, Kaye D. Principles of use of antibacterial agents. Infect Dis Clin North Am. 2004; 18:435–450.
crossref
7. Tunkel AR, van de Beek D, Scheld WM. Acute meningitis. In : Mandell GL, Douglas RG, Bennett JE, Dolin R, Blaser MJ, editors. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia: Churchill Livingstone Elsevier;2015. p. 1097–1137.
8. Kang CI. Principles of antimicrobial therapy in elderly patients. Korean J Med. 2010; 79:362–365.
9. Hessen MT, Kaye D. Principles of selection and use of anti-bacterial agents. In vitro activity and pharmacology. Infect Dis Clin North Am. 2000; 14:265–279.
10. Kim SW. Therapeutic drug monitoring (TDM) of antimicrobial agents. Infect Chemother. 2008; 40:133–139.
crossref
11. Yoon YK, Park CS, Kim JW, Hwang K, Lee SY, Kim TH, Park DY, Kim HJ, Kim DY, Lee HJ, Shin HY, You YK, Park DA, Kim SW. Guidelines for the antibiotic use in adults with acute upper respiratory tract infections. Infect Chemother. 2017; 49:326–352.
crossref
12. Lee MS, Oh JY, Kang CI, Kim ES, Park S, Rhee CK, Jung JY, Jo KW, Heo EY, Park DA, Suh GY, Kiem S. Guideline for antibiotic use in adults with community-acquired pneumonia. Infect Chemother. 2018; 50:160–198.
crossref
13. Kang CI, Kim J, Park DW, Kim BN, Ha US, Lee SJ, Yeo JK, Min SK, Lee H, Wie SH. Clinical practice guidelines for the antibiotic treatment of community-acquired urinary tract infections. Infect Chemother. 2018; 50:67–100.
crossref
14. Kwak YG, Choi SH, Kim T, Park SY, Seo SH, Kim MB, Choi SH. Clinical guidelines for the antibiotic treatment for community-acquired skin and soft tissue infection. Infect Chemother. 2017; 49:301–325.
crossref
15. Korean Society of Infectious Diseases. Korean Society for Chemotherapy. Korean Society of Clinical Microbiology. Clinical guideline for the diagnosis and treatment of gastrointestinal infections. Infect Chemother. 2010; 42:323–361.
16. Korean Society of Infectious Diseases. Korean Society for Chemotherapy. Korean Society of Clinical Microbiology. Korean Society of Cardiology. Korean Society for Thoracic and Cardiovascular Surgery. Clinical guideline for the diagnosis and treatment of cardiovascular infections. Infect Chemother. 2011; 43:129–177.
17. Lee DG, Kim SH, Kim SY, Kim CJ, Min CK, Park WB, Park YJ, Song YG, Jang JS, Jang JH, Jin JY, Choi JH. Evidence-based guidelines for empirical therapy of neutropenic fever in Korea. Infect Chemother. 2011; 43:285–321.
crossref
18. Korean Society of Infectious Diseases. Korean Society for Chemotherapy. Korean Neurological Association. Korean Neurosurgical Society. Korean Society of Clinical Microbiology. Clinical practice guidelines for the management of bacterial meningitis in adults in Korea. Infect Chemother. 2012; 44:140–163.
19. Choi WS, Lee J, Lee HY, Baek JH, Kim YK, Kee SY, Jeong HW, Kim YK, Song JY, Wie SH, Lee JS. Transgovernmental Enterprise for Pandemic Influenza in Korea. Clinical practice guideline for antiviral treatment and chemoprophylaxis of seasonal influenza. Infect Chemother. 2012; 44:233–249.
crossref
20. Choi WS, Baek JH, Seo YB, Kee SY, Jeong HW, Lee HY, Eun BW, Choo EJ, Lee J, Kim YK, Song JY, Wie SH, Lee JS, Cheong HJ, Kim WJ. Transgovernmental Enterprise for Pandemic Influenza in Korea. Severe influenza treatment guideline. Korean J Med. 2014; 86:116–128.
crossref
21. Korean Society for AIDS. Clinical guidelines for the diagnosis and treatment of HIV/AIDS in HIV-infected Koreans. Infect Chemother. 2011; 43:89–128.
22. Korean Society for AIDS. Clinical guidelines for the treatment and prevention of opportunistic infections in HIV-infected Koreans. Infect Chemother. 2012; 44:93–139.
23. Korean Society for AIDS. The 2013 clinical guidelines for the diagnosis and treatment of HIV/AIDS in HIV-infected Koreans. Infect Chemother. 2013; 45:455–461.
24. Korean Society for AIDS. The 2015 clinical guidelines for the diagnosis and treatment of HIV/AIDS in HIV-infected Koreans. Infect Chemother. 2015; 47:205–211.
25. Korean Society for AIDS. The 2018 clinical guidelines for the diagnosis and treatment of HIV/AIDS in HIV-infected Koreans. Infect Chemother. 2019; 51:77–88.
26. Chong YP, Song JY, Seo YB, Choi JP, Shin HS. Rapid Response Team. Antiviral treatment guidelines for Middle East respiratory syndrome. Infect Chemother. 2015; 47:212–222.
crossref
27. Korean Centers for Diseases Control and Prevention. Korean Association of Urogenital Tract Infection and Inflammation. 2016 Korean guidelines for sexually transmitted infections [Internet]. Cheongju: Korean Centers for Diseases Control and Prevention;2017. cited 2019 Apr 7. Available from: http://www.cdc.go.kr/CDC/together/CdcKrTogether0302.jsp?menuIds=HOME006-MNU2804-MNU3027-MNU2979&cid=138110.
28. Pollack LA, Srinivasan A. Core elements of hospital antibiotic stewardship programs from the Centers for Disease Control and Prevention. Clin Infect Dis. 2014; 59:Suppl 3. S97–S100.
crossref
29. Kim HI, Kim SW, Chang HH, Kim HB. A survey of antimicrobial stewardship programs in Korean hospitals. Korean J Med. 2014; 87:173–181.
crossref
30. Kim B, Kim J, Kim SW, Pai H. A survey of antimicrobial stewardship programs in Korea, 2015. J Korean Med Sci. 2016; 31:1553–1559.
crossref
31. Song YJ, Kim M, Huh S, Lee J, Lee E, Song KH, Kim ES, Kim HB. Impact of an antimicrobial stewardship program on unnecessary double anaerobic coverage prescription. Infect Chemother. 2015; 47:111–116.
crossref
32. Park SM, Kim HS, Jeong YM, Lee JH, Lee E, Lee E, Song KH, Kim HB, Kim ES. Impact of intervention by an antimicrobial stewardship team on conversion from intravenous to oral fluoroquinolones. Infect Chemother. 2017; 49:31–37.
crossref
TOOLS
ORCID iDs

Su-Mi Choi
https://orcid.org/0000-0002-8187-5110

Dong-Gun Lee
https://orcid.org/0000-0003-4655-0641

Similar articles