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

The primary goal in the treatment of respiratory tract infections is to pro vide the best possible clinical outcome for the patients. In order for this to occur, one must consider and synthesize a tremendous amount of data, mu ch of it changing continually, Important considerations include the pharmac okinetics of the selected agent, its microbiological potency when used alon e 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. Amon g the topics to be discussed here are the important pharmacodynamic concept s and their role in the determination of clinical efficacy, the newer quino lone agents, newly emerging mechanisms of resistance, and recent countermea sures that have been added to the therapeutic armamentarium. In addition, s pecific strategies designed to combat current resistance trends supported b y several recent publications will be reviewed.