A clinician’s guide to the appropriate and accurate use of antibiotics: the Council for Appropriate and Rational Antibiotic Therapy (CARAT) criteria

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In response to the overuse and misuse of antibiotics, leading to increasing bacterial resistance and decreasing development of new antibiotics, the Council for Appropriate and Rational Antibiotic Therapy (CARAT) has developed criteria to guide appropriate and accurate antibiotic selection. The criteria, which are aimed at optimizing antibiotic therapy, include evidence-based results, therapeutic benefits, safety, optimal drug for the optimal duration, and cost-effectiveness.

Section snippets

The Council for Appropriate and Rational Antibiotic Therapy

The Council for Appropriate and Rational Antibiotic Therapy (CARAT) is an independent, multidisciplinary panel of healthcare professionals, clinicians as well as scientists, established to advocate the appropriate and accurate use of antibiotics. CARAT has developed 5 criteria to assist healthcare providers in selecting the most appropriate and accurate treatment regimens (Table 1). These criteria are designed to help guide healthcare practitioners in using antibiotics where they are

Appropriate antibiotic therapy

The first consideration in choosing appropriate antibiotic therapy should be whether there is an indication for an antimicrobial agent. Indications for an antibiotic include the unambiguous demonstration or the strong suspicion that the etiologic agent is bacterial. In general, the latter should be based on the signs and symptoms of infection, as well as on other factors, including the age of the patient, the patient’s medical history, and the presence or absence of comorbidities. There are

Pharmacokinetic considerations

Pharmacokinetic properties differentiate among classes of antibiotics, and even among antibiotics within the same class, in their ability to eradicate bacteria at drug concentrations attained during therapy.8 Among these properties are the time for which non-protein-bound serum concentration of drug exceeds its minimum inhibitory concentration (MIC); the ratio between peak serum concentration (Cmax) and MIC; and the ratio between drug exposure, measured as area under the serum 24-hour

Summary

Infectious diseases are still a serious problem, compounded by the development of antibiotic resistance in many bacteria and the relative lack of newer antimicrobial agents to combat these multiresistant organisms. In choosing appropriate and accurate antibiotic therapy, the clinician should use the 5 criteria of CARAT described herein (evidence-based results, therapeutic benefits, safety, optimal drug for the optimal duration, and cost-effectiveness). Appropriate aggressive short-course

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