Reserve antibiotic

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As a reserve antibiotic ( English antibiotics of last resort or drugs of last resort ) are antibiotics indicated that for use with strict indications are provided. One reason for this limitation is serious side effects. For example, ciprofloxacin is only indicated for children in the case of severe and very severe bacterial infections with otherwise resistant pathogens. Targeted use of antibiotics can generally reduce the frequency of the development of antibiotic resistance . Therefore, especially newly developed antibiotics such as tigecycline , linezolid and tedizolid are used as reserve antibiotics.

Although antibiotics are used more sparingly in Germany compared to other European countries, in about a third of all cases the prescription is for a remedy called a reserve antibiotic.

Basic considerations for the use of antibiotics

Ideally, a pathogen culture is set up beforehand, with the help of which the sensitivity to various antibiotics is determined using a plate diffusion test ( antibiogram ). The aim is to use a suitable antibiotic. If classic, well-tolerated antibiotics turn out to be ineffective, so-called reserve antibiotics with more side effects are used. As soon as the effectiveness of the substance has been confirmed in this way, therapy can take place, whereby care must be taken that the development of resistance is not promoted by premature discontinuation of the therapy.

Reserve antibiotics - like all antibiotics - have very different areas of application in infections. Many of these drugs are also effective for infections with a vancomycin- resistant Staphylococcus aureus , for example . How carefully the use must be planned was shown, for example, in the experience with the use of linezolid , in which there was a temporary increase in mortality from severe skin and soft tissue infections, because linezolid is only effective against gram-positive and not against gram-negative pathogens and so on infections treated with it were not fully combated. Other antibiotics have significant side effects, e.g. B. Causes kidney damage, and may only be used in an extreme emergency. Even when treating an infection with reserve antibiotics, the treatment of patients with multi-resistant pathogens (e.g. MRSA ) is often difficult and lengthy in clinical use .

List of reserve antibiotics

In its Model List of Essential Medicines in the March 2017 edition, the WHO classified antibiotics into three categories and aims to treat the 21 most common bacterial infectious diseases worldwide. The categories are called ACCESS , whose representatives should always be available, WATCH , whose representatives have an increased resistance potential and should only be used as 1st or 2nd choice for limited, specific indications, and the RESERVE category , whose representatives are only available as a last option Failure of all alternatives should be used.

The reserve group therefore includes:

Web links

Individual evidence

  1. ↑ Klaus Miksits, Helmut Hahn: Basic knowledge of medical microbiology and infectious diseases. Springer, Berlin / Heidelberg 2003, ISBN 3-540-01525-6 , p. 351, ( limited preview in the Google book search).
  2. ^ Judith Günther, Winfried V. Kern, Katrin Nink, Helmut Schröder, Katja de With: As long as they are still working ... (PDF; 595 kB) Analyzes and comments on antibiotic consumption in Germany. Scientific institute of the AOK in cooperation with the University Medical Center Freiburg , January 2003, p. 104 , archived from the original on May 2, 2016 ; accessed on May 22, 2019 .
  3. ↑ Linezolid (Zyvoxid®): Increased mortality with severe skin and soft tissue infections that are not exclusively caused by Gram-positive pathogens - restrictions on use decided ( Memento of July 16, 2013 in the web archive archive.today ), communication from the BfArM, March 16, 2007
  4. ↑ WHO: WHO Model List of Essential Medicines. March 2017, accessed on January 22, 2018 .