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When to stop antibiotics in the critically ill?

Published version
Peer-reviewed

Repository DOI


Type

Article

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Authors

Neilsen, Nathan 
Dean, James T 
Shald, Elizabeth 
Conway Morris, Andrew  ORCID logo  https://orcid.org/0000-0002-3211-3216
Povoa, Pedro 

Abstract

Over the past century, antibiotic usage has skyrocketed in the treatment of critically ill patients. There have been increasing calls to establish guidelines for appropriate treatment and durations of antibiosis. Antibiotic treatment, even when appropriately tailored to the patient and infection, is not without cost. Short term risks—hepatic/renal dysfunction, intermediate effects—concomitant superinfections, and long-term risks—potentiating antimicrobial resistance (AMR), are all possible consequences of antimicrobial administration. These risks are increased by longer periods of treatment and unnecessarily broad treatment courses. Recently, the literature has focused on multiple strategies to determine the appropriate duration of antimicrobial therapy. Further, there is a clinical shift to multi-modal approaches to determine the most suitable timepoint at which to end an antibiotic course. An approach utilising biomarker assays and an inter-disciplinary team of pharmacists, nurses, physicians, and microbiologists appears to be the way forward to develop sound clinical decision-making surrounding antibiotic treatment.

Description

Keywords

32 Biomedical and Clinical Sciences, 3202 Clinical Sciences, Infectious Diseases, Antimicrobial Resistance, Clinical Research, Clinical Trials and Supportive Activities, 4 Detection, screening and diagnosis, 7 Management of diseases and conditions, 4.2 Evaluation of markers and technologies, 7.3 Management and decision making, Infection

Journal Title

Antibiotics

Conference Name

Journal ISSN

2079-6382
2079-6382

Volume Title

Publisher

MDPI AG
Sponsorship
MRC (MR/V006118/1)