Beta-lactam antibiotics can be ranked according to their antimicrobial spectra and their ecological consequences. This can allow for de-escalation in their use in life-threatening infections. The authors are from multiple institutions in France.
Beta-Lactam Antibiotic
Rank
amoxicillin
1
amoxicillin + clavulanic acid
2
third-generation cephalosporin, ureido-/carboxy-penicillin
3
piperacillin + tazobactam, ticarcillin + clavulanic acid, fourth-generation cephalosporin, antipseudomonal third-generation cephalosporin
4
ertapenem
5
imipenem, meropenem, doripenem
6
Factors that may be considered when ranking an antibiotic:
(1) spectrum of activity (from narrow to broader with increasing number)
(2) impact on resistance to colonization
(3) ability to shorten duration of therapy
(4) selection of antimicrobial resistance
It was difficult to develop a consensus definition of de-escalation and those qualities that should be used in deriving the definition.
To read more or access our algorithms and calculators, please log in or register.
Specialty: Infectious Diseases
