• Lowell Ling, Gavin Matthew Joynt, and Jeffrey Lipman.
• Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China.
• Curr Opin Anaesthesiol. 2021 Apr 1; 34 (2): 929892-98.

Purpose Of ReviewAntibiotics are an essential treatment for septic shock. This review provides an overview of the key issues in antimicrobial therapy for septic shock. We include a summary of available evidence with an emphasis on data published in the last few years.Recent FindingsWe examine apparently contradictory data supporting the importance of minimizing time to antimicrobial therapy in sepsis, discuss approaches to choosing appropriate antibiotics, and review the importance and challenges presented by antimicrobial dosing. Lastly, we evaluate the evolving concepts of de-escalation, and optimization of the duration of antimicrobials.SummaryThe topics discussed in this review provide background to key clinical decisions in antimicrobial therapy for septic shock: timing, antibiotic choice, dosage, de-escalation, and duration. Although acknowledging some controversy, antimicrobial therapy in septic shock should be delivered early, be of the adequate spectrum, appropriately and individually dosed, rationalized when possible, and of minimal effective duration.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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