title: [First-line anti-infective treatment in sepsis].
abstract: BACKGROUND
  The Surviving Sepsis Campaign strongly recommends that intravenous antibiotic therapy should be started as early as possible, ideally within the first hour of recognition of severe sepsis or septic shock. There is ample evidence that failure to initiate early antimicrobial treatment correlates with increased morbidity and mortality.
  
  
  OBJECTIVE
  The purpose of this work was to review the recent literature regarding optimal initial antimicrobial treatment in patients with severe sepsis and sepsis shock.
  
  
  METHODS
  A literature review was performed.
  
  
  RESULTS
  The most frequently quoted papers claiming the overriding prognostic importance of early administered antibiotics are retrospective data analyses. However, an equivalent number of studies report that a group of septic patients do not benefit from early administration of antibiotics, but can also be harmed. In these patients, watchful waiting with administration of a targeted antibiotic can be used, thus, avoiding the possible collateral damage from excessive treatment with antibiotics. Treatment with monotherapy is adequate in most cases.
  
  
  CONCLUSIONS
  The administration of antibiotics based on the local epidemiology should be initiated quickly in critically ill patients with severe sepsis and septic shock. In patients who are not in septic shock, treatment can be withheld, while awaiting further studies or clinical assessment to confirm the suspicion of infection.
authors.affiliation: Innere Medizin I, Klinische Abteilung für Infektionen und Tropenmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich, heinz.burgmann@meduniwien.ac.at.
authors.forename: H
authors.initials: H
authors.lastname: Burgmann
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D003422:Critical Care; D024901:Drug Resistance, Multiple, Bacterial; D004358:Drug Therapy; D018479:Early Intervention, Educational; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D007262:Infusions, Intravenous; D018805:Sepsis / Q000188:drug therapy* / Q000401:mortality; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality
chemical_list: D000900:Anti-Bacterial Agents