Clinical Needs for Assays of New Antimicrobial Agents

Abstract

Generally, in out-patient practice an antibiotic is chosen after making a clinical diagnosis and taking into account the most probable causative agents of that particular type of infection. Except in urinary tract infections and some cases of middle ear and throat infections, etiological microbiological tests are rarely done. The dose and duration of antibiotic therapy is decided on empirical bases. Even at hospitals, where more than one-third of the admitted patients obtain antibiotics during the visit (Pestotnik et al. 1990), microbiological diagnosis of the suspected bacterial infection is available in less than half of the cases (Moss et al. 1983). Again, in most instances the treatment is empirical. The dose of antibiotic is determined by crude patient data, such as weight or surface area, age and renal function if the drug is eliminated by kidneys. Excellent handbooks are available for a more individualized prescription of antibiotics (e.g. Norris et al. 1989). These also give the drug concentrations obtained in serum and some other body fluids for the most commonly used doses and ways of administration. Microcomputer-based programs to assist clinical pharmacokinetic consultant services have been developed for aminoglycosides and some other antibiotics (Schentag and Adelman 1983). These may decrease the need for serum concentration measurements of antibiotics (Lumio 1987).