Journal of Antimicrobial Chemotherapy (1981)8, Suppl. ̂ 4. 133—142 Antibiotics of choice in suspected serious sepsis

In hospitalized patients with severe infections caused by Enterobacteriaceae, Pseudomonas or staphylococci, there is a need for broad-spectrum antimicrobial chemotherapy. The choice of agents depends on the local spectrum of bacterial pathogens, their antimicrobial susceptibility, and the cost and availability of antibiotics. A combination of an aminoglycoside, most commonly gentamicin, and a yS-lactam is most often used. There is now a broader choice among new aminoglycosides, including tobramycin and amikacin. Differences in ototoxicity and nephrotoxicity have not been proved to be of clinical relevance. A consideration of the predictability of adequate, non-toxic serum levels, therapeutic ratio, susceptibility to inactivation by /7-lactam antibiotics, and susceptibility to aminoglycoside-inactivating enzymes, suggests that amikacin may be the drug of choice. There is no evidence that the restriction of use of amikacin, without restriction of all aminoglycosides, will have any effect on the emergence of amikacin resistance. It also seems unlikely that third-generation cephalosporins will replace aminoglycosides. Thus amikacin seems likely t