Busting the Myth of “Static vs. Cidal”: A Systemic Literature Review

Abstract

We sought to determine if clinical data validate the dogma that bactericidal antibiotics are more clinically effective than bacteriostatic agents. We performed a systematic literature review of published, randomized controlled trials that compared a bacteriostatic agent to a bactericidal agent in the treatment of clinical, bacterial infections. From among a total of 56 identified trials, 49 found no significant difference in efficacy between bacteriostatic and bactericidal agents. Six trials found that the bacteriostatic agent was superior in efficacy to the bactericidal agent. Only one trial found that the bactericidal agent was superior; in this case, the inferiority of the static agent was explainable by under-dosing of the drug based on pharmacokinetic-pharmacodynamic analysis. Thus, virtually all available data from high quality, randomized controlled trials demonstrate no intrinsic superiority of bactericidal compared to bacteriostatic agents. Other drug characteristics, such as optimal dosing, pharmacokinetics, and tissue penetration, may be more important efficacy drivers.