Effectiveness of antibiotic prophylaxis in critically ill patients

BMJ 1998;317:1526 ( 28 November )

Letters

Effectiveness of antibiotic prophylaxis in critically ill patients

Distinction must be made between tracheal inflammation and pneumonia

Selective decontamination offers no advantage

Antibiotic prophylaxis can lead to contamination with Clostridium difficile

Authors' reply

Distinction must be made between tracheal inflammation and pneumonia

The first 150 words of the full text of this article appear below.

EDITOR $---$ It is ironic that D'Amico et al's meta-analysis of trials of antibiotic prophylaxis for respiratory infection¹ appearsin the same issue as the House of Lords' report on resistanceto antibiotic drugs.² D'Amico et al did not restrict diagnosticcriteria and did not distinguish between tracheobronchitis andpneumonia in their analysis. Although this distinction can bedifficult, it is worth recognising that colonisation of the tracheaand tracheobronchitis are common but trivial events in intubatedpatients and are probably inevitable. Whether their preventionis worth while is doubtful.

It would be interesting to know the comparative prevalence of tracheobronchitis in the 16% of treated and 36% of control patientswho had "respiratory infection" in the trials that D'Amico etal studied. Inappropriate prophylaxis contributes to the overuseof antibiotics. We should remain cautious about topical and systemicprophylaxis for respiratory infection in critically ill patientsand continue to . . . [Full text of this article]

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Relevant Article

Effectiveness of antibiotic prophylaxis in critically ill adult patients: systematic review of randomised controlled trials: Roberto D'Amico, Silvia Pifferi, Cinzia Leonetti, Valter Torri, Angelo Tinazzi, and Alessandro Liberati
BMJ 1998 316: 1275-1285. [Abstract] [Full Text] [PDF]