Antibiotic heterogeneity

SummaryIn modern sepsis management, long-held concerns about the inexorable rise of antimicrobial resistance have led to a key focus on antibiotic stewardship. Among the many strands that come together to provide a complete picture of stewardship is the issue of how antibiotic classes are deployed. Based on consistent results from mathematical modelling studies, the concept of a structured approach to such class use has evolved over the last decade. Whereas antibiotic cycling was initially perceived to be the strongest candidate for investigation in this field, over recent years the focus has shifted to antibiotic heterogeneity. Although there is presently little clinical work available on antibiotic heterogeneity, the available data demonstrate that this is an attractive option for enabling clinicians to make the most of their existing pool of antimicrobial classes by holding at bay, as much as possible, the emergence of resistance.