Many patients in the intensive care unit (ICU) are affected by nosocomial infections. These infections are associated with increased mortality and morbidity and significant additional expenditure. Selective oropharyngeal decontamination (SOD) and selective gastrointestinal decontamination (SDD) consist of topical antibiotics applied to the oropharynx and intestinal tract to prevent colonization by Gram-negative bacteria, Staphylococcus aureus, and yeast. Prophylactic antibiotic therapy. During SOD, topical antibiotics are used only in the oropharynx for the duration of the stay in the ICU. During SDD, topical antibiotics were applied not only to the oropharynx, but also to the intestinal tract during ICU stay, combined with intravenous cefotaxime for the first 4 days in the ICU to preempt commensal respiratory bacterial infections. Treat to SDD is a widely appreciated but highly controversial intervention in the ICU. Although many, but not all, studies have reported a statistically significant reduction in the incidence of ventilator-associated pneumonia (VAP), the outcome benefits such as mortality and shorter ICU length of stay have been reported. Due to the lack of reliably documented outcome benefits, the fear of antibiotic-resistant selection prevailed and SDD was not recommended in most infection prevention guidelines. Cluster-randomised study in 13 ICUs in the Netherlands. SDD and SOD reduced the relative risk (RR) of day 28 mortality by 13% and 11%, respectively, compared to standard therapy (SC, i.e. no SDD or SOD). SOD and SDD are now widely used in the Dutch intensive care unit, but the cost and effectiveness of both treatments have yet to be determined. Therefore, we performed a cost-benefit analysis (CEA) and compared SC, SOD, and SDD using data from a Dutch multicentre study. Additionally, a prophylactic 4-day regimen of cephalosporin-cefotaxime was added to treat latent infections caused by commensal respiratory flora on admission. The choice of cefotaxime was motivated by the assumption that trauma patients have normal respiratory flora that are susceptible to third-generation cephalosporins at the time of trauma and immediate hospitalization. In his later SDD study, the patient population enrolled gradually changed to include surgical and medical patients with extensive medical histories, including previous antibiotic use and transport by bacteria insensitive to cefotaxime. Selective oropharyngeal decontamination (SOD) was then suggested as an alternative to his SDD. This is based on clinical studies suggesting that colonization of the upper respiratory tract plays a more important role than intestinal infection in the pathogenesis of ventilator-associated pneumonia. SOD consists of oropharyngeal administration of the same antibiotic without intragastric administration or systemic prophylaxis. At that time, many patients who were candidates for SDD were being treated with antibiotics for clinical reasons, the number of patients admitted to intensive care units was increasing, and bacteria resistant to second-generation cephalosporins, and it was decided to use 4. A course of days without systemic antibiotics in SOD. Finally, an early study sought to quantify the effect of his SDD on preventing ICU-acquired pneumonia. However, this diagnosis is subject to finding bias and requires appropriate blinding. However, because SDD modifies microbiological culture and sensitivity results, it is probably impractical to maintain study blinding. Instead, recent studies have used patient survival and ICU-acquired bloodstream infections as primary endpoints. Selective gastrointestinal decontamination has a beneficial effect on mortality in adult patients in the general intensive care unit.