So recently I was lectured by an internist regarding an antibiotic choice due to the antibiotic's bacteriostatic properties (clinda). He preferred an antibiotic that is bactericidal (vancomycin) along with Zosyn. We will ignore the fact that this was a patient stung by a wasp the day before, with a fairly large local inflammatory response to his arm that I've seen frequently in the ED. The patient was afebrile, normal VS, the was no induration, no tenderness, and this internist was requesting we admit him to monitor for possible necrotizing infection (eyeroll), but sure as long as you are the one doing the admitting.
I tried to explain to him that bactericidal and bacteriostatic are laboratory definitions and are clinically meaningless, but he was adamant regarding his antibiotic choices. I eventually relented, as he would be the one caring for the patient while he is admitted, but did advise that he read this article from Clinical Infectious Diseases regarding the myth of -cidal vs -static antibiotics. Its a systemic literature review which demonstrates 56 RCTs comparing -cidal vs -static antibiotics, of which 49 showed no significant difference, 6 which demonstrated superiority of the -static agent surprisingly, and only a single RCT that demonstrated superiority of the -cidal agent (although the -static antibiotic was underdosed).
To be fair, I was taught this in medical school as well, and even in residency I had an intensivist try to explain this to me, although I had never actually seen any convincing literature on the subject. I posted this story and article primarily to address dogma that appears to still be present today, and the importance of doing literature reviews on widely held knowledge, as much of what we were taught in medical school and residency have very little evidence base.
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