Ecological impact of preventive antibiotherapy.

Assessing the ecological impact of preventive antibiotherapy in hospital pr actice is an important piece in the strategies aiming at circumventing the development of bacterial resistance. In the present review of the literatur e, two situations will be taken into account : surgical antibioprophylaxis and selective digestive decontamination. Only the consequences of these on bacterial flora will be considered. Despite some discrepancies, only partia lly attributable to methodological differences, data as a whole are consist ent. For antibioprophylaxis, they confirm the importance of a strict observ ance of the right therapeutic regimen, especially the duration of treatment . Selective digestive decontamination unquestionably encounters hazards of selecting a resistant flora. Monitoring the intestinal flora under treatmen t is mandatory. The indications must remain strictly limited. (C) 2000 Edit ions scientifiques et medicales Elsevier SAS.