title: Antibiotic de-escalation.
abstract: Antibiotic 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.
authors.affiliation: Department of Microbiology, Ayrshire & Arran NHS Board, The Ayr Hospital, Dalmellington Road, Ayr KA6 6DX, UK. robert.masterton@aaaht.scot.nhs.uk
authors.forename: Robert G
authors.initials: RG
authors.lastname: Masterton
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage*; D003428:Cross Infection / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004352:Drug Resistance, Microbial; D006801:Humans; D007362:Intensive Care Units; D017410:Practice Guidelines as Topic; D018805:Sepsis / Q000188:drug therapy*
chemical_list: D000890:Anti-Infective Agents