Selecting an appropriate antimicrobial

It is important to select an antimicrobial that is consistent with clinical guideline recommendations¹, local protocols (developed considering local resistance patterns, local epidemiology or antibiograms²), microbiological test results, or advice from an infectious diseases physician or clinical microbiologist.

To select the most appropriate antimicrobial from those reported as susceptible, consider:

• microbiological test results
• the required spectrum of activity (use the narrowest spectrum therapy required)
• the site of infection and the tissue penetration of the antimicrobial at that site
• potential adverse effects of the antimicrobial (see Types of adverse effects of antimicrobials)
• pharmacokinetic and pharmacodynamic properties of the antimicrobial
• drug interactions
• patient factors, including:
  • patient preference
  • whether the patient has a history of antimicrobial hypersensitivity
  • whether the patient has had any recent antimicrobial use
  • whether the patient is pregnant or breastfeeding
  • whether the patient has altered pharmacokinetics
• whether a suitable formulation is available – see Oral and enteral route of administration for antimicrobials
• antimicrobial availability (see Antimicrobial drug shortages)
• antimicrobial stewardship principles.