Antibiotic prophylaxis can lead to contamination with Clostridium difficile - Reply

Authors' replyEDITOR---Unlike Sanderson, we find it interesting rather than ironic that our review was in the same issue of the House of Lords' report that was aimed at stimulating critical thinking against generalised fears of antimicrobial resistance. Critically ill patients undergoing ventilation are at high risk of pneumonia and death, and the issue whether or not they should be routinely treated with antimicrobials deserves great attention.We accessed data on individual patients, which allowed us to ascertain that most patients in all trials were treated with antimicrobials at some point during their stay in an intensive care unit, regardless of the initial policy of the unit. The question is thus no longer whether, but rather when, they should be treated---immediately, as a policy, or only once their infection becomes clinically evident.