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Kyu Y. Rhee, David F. Gardiner, Clinical Relevance of Bacteriostatic versus Bactericidal Activity in the Treatment of Gram-Positive Bacterial Infections, Clinical Infectious Diseases, Volume 39, Issue 5, 1 September 2004, Pages 755–756, https://doi.org/10.1086/422881
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In their recent review article, Pankey and Sabath [1] highlight the arbitrariness of the empirical measures used to define bactericidal and bacteriostatic activities and emphasize the importance of multiple factors, such as target organism, organism burden, site of infection, and intrinsic pharmacodynamic and pharmacokinetic properties of individual antimicrobial agents, as potential determinants of the efficacy of specific antimicrobial agents in different clinical circumstances. Their conclusion, that the potential superiority of bactericidal over bacteriostatic activity is of little clinical relevance, however, is built on a specious line of reasoning. The arguments Pankey and Sabath [1] presented simply emphasize both the inappropriate pharmacodynamic designation of antimicrobial agents as either “bactericidal” or “bacteriostatic” solely on the basis of their mechanism of action and the notable paucity of clinically validated measures that discriminate bactericidal from bacteriostatic activity [2].
Studies by Scheld and Sande [2] using a rabbit model of pneumococcal meningitis have illustrated the inappropriateness of designating antimicrobials as “bactericidal” or “bacteriostatic” solely on the basis of their mechanism of action. These studies demonstrated that chloramphenicol, an antibiotic generally regarded as bacteriostatic, can in fact achieve bactericidal activity against Streptococcus pneumoniae and can achieve microbiologic cure rates comparable to that of ampicillin in the rabbit model of meningitis when mean peak CSF concentrations exceeded the minimum bactericidal concentration for the organism. This study, as well as several others using experimental animal models, also clearly documented the need for bactericidal activity to achieve microbiologic cure of meningitis [3, 4, 5].
