title: Combination therapy for treatment of infections with gram-negative bacteria.
abstract: Combination antibiotic therapy for invasive infections with Gram-negative bacteria is employed in many health care facilities, especially for certain subgroups of patients, including those with neutropenia, those with infections caused by Pseudomonas aeruginosa, those with ventilator-associated pneumonia, and the severely ill. An argument can be made for empiric combination therapy, as we are witnessing a rise in infections caused by multidrug-resistant Gram-negative organisms. The wisdom of continued combination therapy after an organism is isolated and antimicrobial susceptibility data are known, however, is more controversial. The available evidence suggests that the greatest benefit of combination antibiotic therapy stems from the increased likelihood of choosing an effective agent during empiric therapy, rather than exploitation of in vitro synergy or the prevention of resistance during definitive treatment. In this review, we summarize the available data comparing monotherapy versus combination antimicrobial therapy for the treatment of infections with Gram-negative bacteria.
authors: The Johns Hopkins Medical Institutions, Department of Medicine, Division of Pediatric Infectious Diseases, Baltimore, Maryland, USA. ptamma1@jhmi.edu
authors: Pranita D
authors: PD
authors: Tamma
authors: Sara E
authors: SE
authors: Cosgrove
authors: Lisa L
authors: LL
authors: Maragakis
mesh_terms: D000617:Aminoglycosides / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D024901:Drug Resistance, Multiple, Bacterial; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D024841:Fluoroquinolones / Q000627:therapeutic use; D006090:Gram-Negative Bacteria / Q000472:pathogenicity*; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D009503:Neutropenia / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D016896:Treatment Outcome; D047090:beta-Lactams / Q000627:therapeutic use
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D047090:beta-Lactams