title: Combination antimicrobial therapy for bacterial infections. Guidelines for the clinician.
abstract: Therapy with antimicrobial combinations has been used as long as antimicrobials have been available. Combinations of antibiotics are often used to take advantage of different mechanisms of action and/or toxicity profiles. Well established indications for combination antimicrobial therapy include: (a) empirical treatment of life-threatening infections; (b) treatment of polymicrobial infections; (c) prevention of the emergence of bacterial resistance; and (d) for synergism. Disadvantages of combination therapy include: (a) increased expense; (b) increased risk of adverse effects; (c) antagonism; and (d) superinfection. Combination antimicrobial therapy should be considered for the treatment of serious Gram-negative infections caused by Enterobacter cloacae, Pseudomonas aeruginosa and Serratia marcescens, and certain Gram-positive infections caused by Enterococcus spp. and Staphylococcus spp. Selection of agents should be dependent upon local susceptibility patterns, clinical experience, site of infection, potential toxicities and cost.
authors.affiliation: Department of Pharmacy, Detroit Receiving Hospital, Michigan, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Rybak
authors.forename: B J
authors.initials: BJ
authors.lastname: McGrath
mesh_terms: D000900:Anti-Bacterial Agents; D001424:Bacterial Infections / Q000188:drug therapy*; D004357:Drug Synergism; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy; D006801:Humans; D017410:Practice Guidelines as Topic
chemical_list: D000900:Anti-Bacterial Agents