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The acute appendicitis (AA) is an infection of the vermiform appendix and conservative antibiotic treatment is regularly mentioned since 50 years. Its success depends on the susceptibility of bacteria to empiric antibiotic therapy. The main bias of the studies comparing conservative antibiotic treatment versus appendectomy is that AA can not be proven histologically during medical treatment. However, after antibiotic conservative, 12-23% of patients are operated early after revaluation, and 11 to 15% in the first year for a total of 25% to 40% failure of conservative antibiotic treatment when proposed in first intention. In case of complicated appendicitis, severe infection and peritonitis, surgical treatment should be carried out urgently and remains the gold standard.

Major advances in imaging and microbiological procedures have changed the diagnostic approach of infective endocarditis. New imaging tools have improved the search of local complications, systemic embolism and diagnosis of infection of cardiac devices. Moreover, microbiological diagnosis has been transformed by molecular techniques as long as these procedures have highlighted microorganisms thus far neglected by classical techniques. Despite these advances, endocarditis remained a clinical diagnosis which still depends on a high index of clinical suspicion.

Vancomycin is an antibiotic for exclusive hospital use administrated in intravenous infusion to treat systemic infections. It is mainly eliminated by kidneys and potentially nephrotoxic. Data available show that Therapeutic Drug Monitoring (TDM) of vancomycin is highly recommended. It aims to ensure efficacy and avoid resistance by maintaining trough plasma concentrations above the MIC. Secondary, vancomycine TDM may be indicated to prevent nephrotoxicity in high risk patients. TDM is often underwent at steady state (48 to 72 h after the treatment initiation) unless in case of renal impairment (24 h). While compared with intermittent administration, continuous infusion did not result in prognosis improvement; however it resulted in lower pharmacokinetic variability and better cost-efficiency. Targeted trough concentrations for intermittent infusion are between 15 and 20 mg/L (up to 25-30 mg/L for GISA). In case of continuous infusion, targets are higher (25 to 40 mg/L)., (© 2011 Société Française de Pharmacologie et de Thérapeutique.)

Antibiotics are usually prescribed for serious bacterial infections. The knowledge of ecological niche of each bacterium, mechanisms of action and resistance to antibiotics and the correct interpretation of a direct exam of microbiological samples are essential to improve the use of antibiotics. Finally, the update of the epidemiology of resistance is necessary to interpret the susceptibility tests and for the optimal use of empirical antibiotherapy.