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- Robert G Masterton.
- Department of Microbiology, Ayrshire & Arran NHS Board, The Ayr Hospital, Dalmellington Road, Ayr KA6 6DX, UK. robert.masterton@aaaht.scot.nhs.uk
- Crit Care Clin. 2011 Jan 1;27(1):149-62.
AbstractAntibiotic de-escalation is a mechanism whereby the provision of effective initial antibiotic treatment is achieved while avoiding unnecessary antibiotic use that would promote the development of resistance. It is a key element within antimicrobial stewardship programs and treatment paradigms for serious sepsis. The embodiment of de-escalation is that based on microbiology results around the day 3 therapy point; the empiric antibiotic(s) that were started are stopped or reduced in number and/or narrowed in spectrum. Data are presented here which demonstrate that de-escalation is clinically effective and appropriate. However, the need for further studies, particularly in terms of realization of full benefits as well as implementation tools, is highlighted. De-escalation ought now to form a part of routine antimicrobial management, though how best to do it and the full breadth and scope of benefits remain to be identified.Copyright © 2011 Elsevier Inc. All rights reserved.
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