Judicious Use of Antibiotics


The overuse of antibiotics is widely accepted as a major driver of some emerging infections (such as Clostridium difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance (AMR) globally.

The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria including extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella species, andcarbapenem-resistant Klebsiella pneumoniae and Pseudomonas aeruginosa.

Antimicrobial resistance is a natural phenomenon that occurs as microbes evolve. However, human activities have accelerated the pace at which microorganisms develop and disseminate resistance. Inappropriate and injudicious use of antibiotics and other antimicrobials, as well as poor prevention and control of infections, are contributing to the development of AMR.

It is absolutely necessary that every clinicians treating infections understands the underlying epidemiology and clinical consequences of AMR.

The global nature of AMR calls for a global response, both in the geographic sense and across the whole range of sectors involved.

In 2016 an international task force from 79 different countries has joined AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections).

This collaboration involves an international multidisciplinary task force, promoted by the World Society of Emergency Surgery (WSES), and endorsed by: the Surgical Infection Society (SIS), the American Association for the Surgery of Trauma (AAST), the Panamerican Trauma Society (PTS), the Indian Society for Trauma and Acute Care (ISTAC), the Korean Society of Acute Care Surgery (KSACS), the World Society of Abdominal Compartment Syndrome (WSACS), the South African Society of Clinical Microbiology (SASCM), the Hellenic Society for Chemotherapy, the Italian Society of Anti-Infective Therapy (SITA), The Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Therapy (SIAARTI), the Italian Society of Surgery (SIC), the Italian Association of Hospital Surgeons (ACOI), the Italian Society of Emergency Surgery and Trauma (SICUT), the Italian Society of Intensive Care (SITI) and the World Alliance Against Antibiotic Resistance (WAAAR).

Judicious, careful and rational use of antimicrobials is an integral part of good clinical practice. This attitude maximizes the utility and therapeutic efficacy of treatment, and minimizes the risks associated with emerging infections and the selection of resistant pathogens.

Although most clinicians are aware of the problem of antimicrobial resistance, most underestimate its importance.

Judicious antimicrobial management decisions is an integral part of responsible medication prescribing behavior.

Massimo Sartelli