Résumé
Antibacterial agents kill bacteria, but allow growth of other organisms, including resistant bacteria. Critically ill patients need different doses to those in the wards. Often critically ill patients have augmented renal clearance predisposing them to underdosing and the development of resistance. It is therefore prudent to use high-dose, short courses and as narrow a spectrum as possible. Therapeutic drug monitoring not only for toxicity but also for efficacy (including for beta-lactams) can help with dosing requirements. Delay in the initiation of antibiotics in septic shock is harmful, but cultures need to be taken prior to initiation of the antibiotic. Evidence suggests double Gram-negative cover is unnecessary. Prophylactic antibiotics should be administered just prior to surgery and continued for any length of time. Infection control is just as important, if not more so, in treating infected patients.