De-escalation in lower respiratory tract infections.
OBJECTIVE
The present article reviews recent data on the de-escalation of empirical antibiotic treatment on pneumonia, with special attention to newer strategies aimed at increasing adequacy and minimizing resistance emergence risks in ventilator-associated pneumonia.


RESULTS
A de-escalation strategy is feasible in a large proportion of patients with pneumonia, and at least two reports have associated de-escalation with a significantly better survival. Combined with other strategies, such as using biomarkers (e.g. C-reactive protein or procalcitonin), antibiotic heterogeneity, adherence to local microbiological flora, objective clinical criteria of non-response and of clinical ventilator-associated pneumonia resolution, they contribute to rationalizing and individualizing antimicrobial therapy.


CONCLUSIONS
A patient-based approach with prompt adequate empirical therapy, using broad-spectrum antibiotics based on reliable local microbiological data with streamlining as soon as microbiological data become available, allow outcomes to be improved and the emergence of resistance to be minimized.
Lisboa
Thiago
T
Hospital de Clinicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Rello
Jordi
J
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D006801:Humans; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D012141:Respiratory Tract Infections / Q000188:drug therapy
D000900:Anti-Bacterial Agents