Alternatives to Antibiotics

Infection remains one of the main reasons for admission to intensive care units (ICU). As a consequence, more than 60 % of ICU patients receive antibiotics during their stay in the ICU, despite implementation of antibiotic stewardship programs to improve the quality of antibiotic use.

In most countries antibiotic consumption is mainly driven by pulmonary infections, such as community acquired pneumonia (CAP), healthcare associated pneumonia (HCAP), hospital acquired pneumonia (HAP), and ventilator associated pneumonia (VAP). Bacterial resistance has concurrently increased, especially for Gram negative bacilli, including Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii, while prevalence of methicillin resistance among Staphylococcus aureus has remained stable or declined in most European countries.

Yet, very few new antibiotics have been developed over the past decade and only a few novel drugs are in the development pipeline of pharmaceutical companies. To meet the current and emerging unmet medical needs, alternative therapeutic options to antibiotics, including new strategies, have to be considered in the ICU. Among the several non-antibiotic strategies that are currently being investigated in the ICU, we focused on monoclonal antibodies and bacteriophages but some others such as vaccination, immune stimulation, antibacterial peptide, or probiotics could also bring encouraging results in the near future.

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