Basic approach for the selection of antibacterial agents

Abstract

In these guidelines, antimicrobials are selected according to the severity ranking and in conformance with the health insurance system in Japan and the prevailing situation with regard to hospital-acquired pneumonia. Reference was made to the 2005 ATS/IDSA guidelines as precedents for guidelines regarding hospital-acquired pneumonia. After examining these guidelines, the need to consider the medical system and particularities of infectious disease treatment in each country was identified. Preparation of these guidelines was thus necessary to take into consideration special conditions in Japan, including the long period of hospitalization, large number of patients with mild pneumonia, and large differences in test methods and antimicrobial doses. In the selection of specific antimicrobials, the mild group (A) corresponds to the early-onset group or the group with no risk factors for drug-resistant strains of bacteria in the ATS/IDSA guidelines, and the severe group (C) corresponds to the late group or group with risk of drug-resistant bacteria. Antimicrobial selection for the moderate group (B) between these two groups is carried out with consideration of drug-resistant bacteria, including Pseudomonas aeruginosa. In cases when MRSA is suspected, administration of anti-MRSA agents is recommended in addition to the antimicrobial for the respective group. Moreover, according to pharmacokinetic/pharmacodynamic theory, a sufficient antimicrobial dose needs to be administered in the early stage. As the efficacy of aminoglycoside drugs may be low using the doses and administration methods applied in Japan, administration using therapeutic drug monitoring is emphasized.