Why use bacteriostatic antibiotics

Randomized comparison of linezolid PNU versus oxacillin-dicloxacillin for treatment of complicated skin and soft tissue infections Antimicrob Agents Chemother 44 Safety and efficacy of intravenous tigecycline in treatment of community-acquired pneumonia: results from a double-blind randomized phase 3 comparison study with levofloxacin Diagn Microbiol Infect Dis 63 52 Efficacy and safety of azithromycin versus benzylpenicillin or erythromycin in community-acquired pneumonia Eur J Clin Microbiol Infect Dis 14 7.

Tigecycline versus levofloxacin for the treatment of community-acquired pneumonia: European experience J Chemother 20 Suppl 1 28 Clarithromycin versus amoxicillin-clavulanic acid in the treatment of community-acquired pneumonia Eur J Clin Microbiol Infect Dis 16 8.

Clinical efficacy and safety of a short regimen of azithromycin sequential therapy vs standard cefuroxime sequential therapy in the treatment of community-acquired pneumonia: an international, randomized, open-label study J Chemother 17 Clinical efficacy of intravenous followed by oral azithromycin monotherapy in hospitalized patients with community-acquired pneumonia.

Erythromycin compared with a combination of ampicillin plus flucloxacillin for the treatment of community acquired pneumonia in adults J Antimicrob Chemother 14 75 9. A comparative trial of cephaloridine and erythromycin in hospitalized pneumonic patients Postgrad Med J 43 Suppl 43 53 4. Integrated results of 2 phase 3 studies comparing tigecycline and levofloxacin in community-acquired pneumonia Diagn Microbiol Infect Dis 61 Efficacy and safety of tigecycline versus levofloxacin for community-acquired pneumonia BMC Pulm Med 9 Roxithromycin versus penicillin in the treatment of erysipelas in adults: a comparative study Br J Dermatol 9.

Safety and efficacy of tigecycline in treatment of skin and skin structure infections: results of a double-blind phase 3 comparison study with vancomycin-aztreonam Antimicrob Agents Chemother 49 Efficacy and safety of tigecycline monotherapy compared with vancomycin-aztreonam in the treatment of complicated skin and skin structure infections in patients from India and Taiwan J Microbiol Immunol Infect 44 The efficacy and safety of tigecycline in the treatment of skin and skin-structure infections: results of 2 double-blind phase 3 comparison studies with vancomycin-aztreonam Clin Infect Dis 41 Suppl 5 S Efficacy and safety of tigecycline monotherapy compared with vancomycin plus aztreonam in patients with complicated skin and skin structure infections: results from a phase 3, randomized, double-blind trial Int J Infect Dis 9 Efficacy and safety of tigecycline monotherapy vs.

Efficacy of tigecycline versus ceftriaxone plus metronidazole for the treatment of complicated intra-abdominal infections: results from a randomized, controlled trial Surg Infect 13 9. A multicentre, open-label, randomized comparative study of tigecycline versus ceftriaxone sodium plus metronidazole for the treatment of hospitalized subjects with complicated intra-abdominal infections Clin Microbiol Infect 16 Azithromycin versus ceftriaxone for the treatment of uncomplicated typhoid fever in children Clin Infect Dis 31 8.

Treatment of plague with gentamicin or doxycycline in a randomized clinical trial in Tanzania Clin Infect Dis 42 Intravenous mecillinam, trimethoprim and ampicillin in acute pyelonephritis Drugs Exp Clin Res 9 Efficacy and safety of tigecycline for the treatment of infectious diseases: a meta-analysis Lancet Infect Dis 11 Randomized phase 2 trial to evaluate the clinical efficacy of two high-dosage tigecycline regimens versus imipenem-cilastatin for treatment of hospital-acquired pneumonia Antimicrob Agents Chemother 57 Efficacy and safety of linezolid compared with vancomycin in a randomized, double-blind study of febrile neutropenic patients with cancer Clin Infect Dis 42 Increased susceptibility of Pseudomonas aeruginosa to macrolides and ketolides in eukaryotic cell culture media and biological fluids due to decreased expression of oprM and increased outer-membrane permeability Clin Infect Dis 55 Interaction of drug- and granulocyte-mediated killing of Pseudomonas aeruginosa in a murine pneumonia model J Infect Dis doi Oxford University Press is a department of the University of Oxford.

It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Introduction. Transparency declarations. Bacteriostatic versus bactericidal antibiotics for patients with serious bacterial infections: systematic review and meta-analysis.

Johannes Nemeth , Johannes Nemeth. Oxford Academic. Gabriela Oesch. Stefan P. Revision requested:. Revision received:. Select Format Select format. Permissions Icon Permissions. Open in new tab. After screening titles and abstracts, 81 articles were selected for full-text screening Figure 1. Thirty-three studies met the inclusion criteria Table 2. The bacteriostatic agents included tigecycline, linezolid, macrolides, sulphonamides, tetracyclines and streptogramins.

Diseases under study included pneumonia 13 studies 6 , 11 , 15 — 19 , 21 — 26 , skin and soft tissue infections 8 studies 7 , 8 , 27 — 32 , intra-abdominal infections 4 studies 33 — 36 and others 8 studies 10 , 20 , 37 — No trials in neutropenic patients or patients with endocarditis or meningitis met inclusion criteria. All studies except one study on children with typhoid included adults only. Study characteristics. Type of study. Antibiotics, bactericidal.

Antibiotics, bacteriostatic. Bergallo et al. Table 2. Open in new tab Download slide. Figure 1. Data from patients were available for meta-analysis of clinical cure rates. Of these patients, Meta-analysis indicated that clinical cure rates were not different between bactericidal and bacteriostatic drugs [risk ratio RR , 0.

For the other drug classes, an insufficient number of studies were found, precluding statistical analysis. Subgroup analyses revealed that treatment with linezolid appeared to be associated with better clinical cure rates compared with its bactericidal comparator RR, 0. In meta-regression, combined cure rates of trials using linezolid were better than those from tigecycline trials RR, 1.

There was no benefit detectable for clinical cure rates among subgroups of bactericidal antibiotics Figure 3. Figure 2. Figure 3. There was no significant increase in overall mortality in the patient group treated with bacteriostatic antibiotics compared with patients treated with bactericidal antibiotics RR, 0. An increased mortality was found in studies using tigecycline in the bacteriostatic regimen group RR, 0. In meta-regression, there was a strong trend towards reduced mortality in studies using linezolid compared with tigecycline trials RR, 0.

There was no mortality benefit detectable for subgroups of bactericidal antibiotics Figure 5. Figure 4. Figure 5. We performed subgroup analyses of the most frequent diseases: abdominal infections, skin and soft tissue infections and pneumonia. No differences in clinical outcome between diseases could be found Figure 6. Although that interpretation is what the names seem to imply, that interpretation is wrong. Two definitions are important to clarify here.

First, the minimum inhibitory concentration MIC is defined as the concentration that inhibits visible bacterial growth at 24 hours of growth in specific media, at a specific temperature, and at a specific carbon dioxide concentration. Second, the minimum bactericidal concentration MBC is the concentration of a drug that results in a 1,fold reduction in bacterial density at 24 hours of growth in the same specific conditions.

Similarly, an antibiotic that achieves a fold, or even a fold, reduction in bacterial density at a concentration of 2- to 4-fold above the MIC is characterized as bacteriostatic, even though it demonstrates impressive killing ability. All antibiotics that are considered bacteriostatic do kill bacteria in vitro , just at concentrations that are farther above their MICs than bactericidal agents. These purely laboratory definitions are somewhat arbitrary.

Based in Alexandria, Virginia, IDSA is a professional society representing more than 7, physicians and scientists who specialize in infectious diseases. Note: Content may be edited for style and length. Science News. ScienceDaily, 22 October Infectious Diseases Society Of America. Bacteria-Killing Vs. Retrieved November 9, from www. Because drug penetration may be poor in osteomyelitis because of decreased vascular supply, it might seem logical to choose a bactericidal agent for therapy; however, clindamycin, a bacteriostatic agent, achieves high concentrations in bone and is considered an appropriate agent for the treatment of gram-positive bacterial osteomyelitis [ 91 , 92 ].

Successful outcome of osteomyelitis is determined by adequate surgical debridement and choice of an antimicrobial agent to which the organism is susceptible, rather than that agent's bactericidal properties.

The use of bactericidal antibacterial therapy has been suggested to treat bacterial infections in severely neutropenic patients [ 93 , 94 ]. Gram-positive bacteria have now become an important difficult-to-treat cause of infection in neutropenic patients [ 93 , 95 , 96 ]. Bacteriostatic agents have not been adequately studied in these patients. Table 1 lists bactericidal and alternative bacteriostatic antibacterial classes used for serious gram-positive bacterial infections. Bactericidal versus bacteriostatic antibacterial classes for serious gram-positive bacterial infections.

Some data indicate that potentially adverse clinical consequences may result from the rapid lytic action of bactericidal antibacterial agents [ 97 , 98 ]. Endotoxin surge is well documented after antibacterial therapy in the CSF of infants with gram-negative bacterial meningitis [ 99 , ]. In meningitis due to S. Even chloramphenicol is lytic to S. Exotoxins of staphylococci and streptococci may produce toxic shock syndrome. Although these bacteria are usually susceptible to clindamycin, its bacteriostatic action had for some time been considered a disadvantage, and bactericidal antibacterial agents were preferred.

However, clindamycin has been shown to completely inhibit toxic shock syndrome toxin-1 production by S. At high bacterial loads, clindamycin is also more effective than penicillin in reducing mortality of experimental thigh infection with either Clostridium perfringens [ 62 ] or S. Clindamycin is now considered a major component of therapy for staphylococcal and streptococcal toxic shock syndrome [ ].

The presumption of the superiority of in vitro bactericidal over bacteriostatic action in the treatment of gram-positive bacterial infections is intuitive rather than based on rigorous scientific research.

Most authors agree that the possible superiority of bactericidal activity over bacteriostatic antibacterials is of little clinical relevance in the treatment of the great majority of gram-positive bacterial infections.

The one proven indication for bactericidal activity is in enterococcal endocarditis. Meningitis is usually treated with bactericidal agents, but bacteriostatic agents, such as chloramphenicol and linezolid, have been used effectively. Pankey is greatly appreciated. Google Scholar. Google Preview. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.

Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Abstract. Disadvantages of Bactericidal Action. Advantages of Bacteriostatic Action. Pankey , G. Reprints or correspondence: Dr. George A. Oxford Academic. Cite Cite G. Select Format Select format. Permissions Icon Permissions. Abstract The distinction between bactericidal and bacteriostatic agents appears to be clear according to the in vitro definition, but this only applies under strict laboratory conditions and is inconsistent for a particular agent against all bacteria.

Open in new tab Download slide. Google Scholar Crossref. Search ADS. The emergence of Staphylococcus aureus with reduced susceptibility to vancomycin in Japan.

Secrets of success of a human pathogen: molecular evolution of pandemic clones of methicillin-resistant Staphylococcus aureus. First clinical isolate of vancomycin-intermediate Staphylococcus aureus in a French hospital [letter]. New faces of an old pathogen: emergence and spread of multidrug-resistant Streptococcus pneumoniae. Tests for bactericidal effects of antibacterial agents: technical performance and clinical relevance.

Serum bactericidal test: past, present, and future use in the management of patients with infections. Google Scholar PubMed. Methods for determining bactericidal activity of antibacterial agents; approved guideline. Medium-dependent variation in bactericidal activity of antibiotics against susceptible Staphylococcus aureus.