Table 1.

Factors which contribute at various levels to the choice of empirical or selective antimicrobial chemotherapy, when resistant Gram-positive cocci may be of concern

– Local epidemiology maps, and hospital epidemiology (nosocomial) maps – Ethiological diagnosis and in vitro antimicrobial susceptibility assays – Patient's conditions and eventual underlying disorders and supporting conditions – Patient's status of immune competence – Predisposing conditions – Appropriate physician's prescription – Spectrum of activity of prescribed antimicrobial agents, and their eventual association (to exploit additive or synergistic activity) – Drug bioavailability characteristics (including drug disposition and diffusion, protein link, volume of distrubution, tissue and intracellular penetration, pharmacokinetic and pharmacodynamic properties) – Serum and tissue half-life of selected compounds – Expected or assessed antimicrobial resistance pattern – Drug metabolism, eventual post-antibiotic effect, elimination routes – Peak levels, minimal inhibitory concentrations (MIC), mimimal bactericidal concentrations (MBC), area under the curve (AUC), and related pharmacokinetic/pharmacodynamic parameters – Drug-drug interactions (increased or reduced activity and toxicity), drug metabolism (active or inactive metabolites) – Comprehensive duration of antimicrobial chemotherapy courses – Comprehensive tolerabilily, and toxicity issues in otherwise healthy, or compromised subjects – Patient's compliance (also related to eventual concomitant pharmacological treatments) – Crude and comprehensive costs of administration and delivery of each single drug in the relevant context (including possibility to switch from a parenteral to an oral route of administration) – Comprehensive pharmacoeconomic issues