Busting the Myth of "Static vs Cidal": A Systemic Literature Review

Clin Infect Dis. 2018 Apr 17;66(9):1470-1474. doi: 10.1093/cid/cix1127.


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 (RCTs) that compared a bacteriostatic agent to a bactericidal agent in the treatment of clinical, bacterial infections. Of 56 identified trials published since 1985, 49 found no significant difference in efficacy between bacteriostatic and bactericidal agents. In 6 trials it was found that the bacteriostatic agent was superior to the bactericidal agent in efficacy. Only 1 trial found that the bactericidal agent was superior; in that case, the inferiority of the static agent was explainable by underdosing of the drug based on pharmacokinetic-pharmacodynamic analysis. Thus, virtually all available data from high-quality, RCTs 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.

Publication types

  • Research Support, N.I.H., Extramural
  • Systematic Review

MeSH terms

  • Anti-Bacterial Agents / classification*
  • Anti-Bacterial Agents / therapeutic use*
  • Bacteria / drug effects*
  • Bacterial Infections / drug therapy*
  • Humans
  • Microbial Sensitivity Tests
  • Randomized Controlled Trials as Topic
  • Treatment Outcome


  • Anti-Bacterial Agents