title: Antibiotic therapy in patients with septic shock.
abstract: The management of a patient with severe sepsis is first to diagnose the infection, to collect samples immediately after diagnosis and to initiate promptly broad-spectrum antibiotic treatment. The choice of empirical antimicrobial therapy should be based on host characteristics, site of infection, local ecology and the pharmacokinetics and pharmacodynamics of the antibiotics. In severe infection, guidelines recommend the use of a combination of antibiotics. After results of cultures are obtained, treatment should be re-evaluated to either de-escalate or escalate the antibiotics. This is associated with optimal costs, decreased incidence of superinfection and reduced development of antimicrobial resistance. All these steps should be based on written protocols, and compliance to these protocols should be monitored continuously in order to detect violations and implement corrective procedures.
authors.affiliation: Service d'Anesthésie et de Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Université de la Méditerranée, Marseille, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Textoris
authors.forename: Sandrine
authors.initials: S
authors.lastname: Wiramus
authors.forename: Claude
authors.initials: C
authors.lastname: Martin
authors.forename: Marc
authors.initials: M
authors.lastname: Leone
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D019983:Guideline Adherence; D006801:Humans; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents