Topical nonabsorbable antibiotics

The aim of the application of topical antibiotics is the selective elimination of the aerobic potentially pathogenic micro-organisms from the oropharyngeal cavity and gastrointestinal tract, thereby preventing endogenous infections and the emergence of resistance. The classical Groningen SDD regimen comprises polymyxin, tobramycin, and amphotericin B (PTA regimen) (Table 1). It covers all aerobic Gram-negative potentially pathogenic micro-organisms, Staph. aureus, and yeast, but has relatively little effect on the indigenous flora. Polymyxin is the cornerstone of SDD because it has a broad Gram-negative spectrum and there is no acquired resistance to this drug. However, the gap in the spectrum of polymyxin includes Proteus and Providencia species, and therefore it should be combined with another agent (e.g. an aminoglycoside or a fluoroquinolone). Tobramycin is the drug of choice because it has a potentiating bactericidal effect on Pseudomonas and Acinetobacter species.

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