New antibiotics in pulmonary and critical care medicine: Focus on advanced generation quinolones and cephalosporins

The primary goal in the treatment of respiratory tract infections is to provide the best possible clinical outcome for the patients. In order for this to occur, one must consider and synthesize a tremendous amount of data, much of it changing continually, Important considerations include the pharmacokinetics of the selected agent, its microbiological potency when used alone and in combination with various other agents, and the susceptibilities of the target organisms. Gram-negative bacilli remain among the most frequent cause of bacterial infection in the intensive care unit and in debilitated populations. They also have the ability to resist the best therapies. Among the topics to be discussed here are the important pharmacodynamic concepts and their role in the determination of clinical efficacy, the newer quinolone agents, newly emerging mechanisms of resistance, and recent countermeasures that have been added to the therapeutic armamentarium. In addition, specific strategies designed to combat current resistance trends supported by several recent publications will be reviewed.