LAUSR

One of the most common and challenging situations that physicians face in their daily clinical practice is the diagnosis and management of patients with acute respiratory infections. Until recently, the most common and “practical” approach followed by clinicians was to treat the majority of these patients empirically with antibiotics. The pragmatic argument has been that antibiotics are prescribed to treat the bacteria causing the respiratory infection, even if symptoms suggest a viral infection because of the risk of a concomitant or potential superimposed bacterial infection. Arguments against this practical approach have become more evident in recent years as new studies have shed light on the true impact of this strategy. Traditionally, most concerns regarding the use of unnecessary antimicrobial agents have been related to the development of resistant bacteria [1]. This concern was mostly perceived as an epidemiological, global issue, not affecting the individual patient whose symptoms need to be addressed at that precise moment. Studies in the last decade, however, have revealed the negative effects of antimicrobial therapy on the composition of the microbiome of the individual patient and its potential consequences [2, 3]. We learned the importance of the microbiome in directing the normal physiological maturation of the immune system and how changes on its composition can increase the risk of a number of immune-mediated and infectious conditions affecting the gastrointestinal and respiratory tracts. Furthermore, studies have shown that excessive antibiotic use can be associated with poor outcomes in critically ill children [4, 5]. This evidence has dramatically shifted the perception of the impact of inappropriate antibiotic use, from a vague global concern to the individual patients we treat every day in our clinical practice. This new awareness has encouraged the establishment of new antimicrobial stewardship programmes aimed at educating clinicians about the appropriate use of antimicrobial agents [6, 7]. Advancing host transcriptomics for diagnosis of infectious diseases http://ow.ly/4CQq30c24SM