• Jose Garnacho-Montero, Ana Escoresca-Ortega, and Esperanza Fernández-Delgado.
• aCritical Care and Emergency Department, Intensive Care Unit, Virgen del Rocío University Hospital bInstituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla cSpanish Network for Research in Infectious Disease (REIPI), Virgen del Rocío University Hospital, Sevilla, Spain.
• Curr. Opin. Infect. Dis. 2015 Apr 1;28(2):193-8.

Purpose Of ReviewAn antimicrobial policy consisting of the initial use of wide-spectrum antimicrobials followed by a reassessment of treatment when culture results are available is termed de-escalation therapy. Our aim is to examine the safety and feasibility of antibiotic de-escalation in critically ill patients providing practical tips about how to accomplish this strategy in the critical care setting.Recent FindingsNumerous studies have assessed the rates of de-escalation therapy (range from 10 to 60%) in patients with severe sepsis or ventilator-associated pneumonia as well as the factors associated with de-escalation. De-escalation generally refers to a reduction in the spectrum of administered antibiotics through the discontinuation of antibiotics or switching to an agent with a narrower spectrum. Diverse studies have identified the adequacy of initial therapy as a factor independently associated with de-escalation. Negative impact on different outcome measures has not been reported in the observational studies. Two randomized clinical trials have evaluated this strategy in patients with ventilator-associated pneumonia or severe sepsis. These trials alert us about the possibility that this strategy may be linked to a higher rate of reinfections but without an impact on mortality.SummaryAntibiotic de-escalation is a well tolerated management strategy in critically ill patients but unfortunately is not widely adopted.

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