From the Guidelines
The recommended duration of antibiotic therapy for sepsis is 7 to 10 days.
Key Considerations
- The duration of therapy may be longer in patients with a slow clinical response, undrainable foci of infection, bacteremia with Staphylococcus aureus, or immunologic deficiencies, including neutropenia 1.
- Shorter courses may be appropriate in patients with rapid clinical resolution following effective source control of intra-abdominal or urinary sepsis and those with anatomically uncomplicated pyelonephritis 1.
- Procalcitonin levels can be used to support shortening the duration of antimicrobial therapy in sepsis patients or discontinuation of empiric antibiotics in patients who initially appeared to have sepsis, but subsequently have limited clinical evidence of infection 1.
Important Recommendations
- Daily assessment for de-escalation of antimicrobial therapy in patients with sepsis and septic shock is recommended 1.
- Empiric combination therapy should not be administered for more than 3 to 5 days, and de-escalation to the most appropriate single therapy should be performed as soon as the susceptibility profile is known 1.
From the Research
Duration of Antibiotic Therapy for Sepsis
- The recommended duration of antibiotic therapy for sepsis is typically limited to 7 to 10 days, as stated in the 2016 International Guidelines for the Management of Sepsis and Septic Shock 2.
- Longer duration of antibiotic therapy may be considered if response is slow, if there is inadequate surgical source control, or in the case of immunologic deficiencies 3.
- De-escalation and shortened courses of antimicrobials must be considered for most patients, except in some justified circumstances 4, 5.
Factors Influencing Antibiotic Therapy Duration
- The severity of sepsis and the presence of organ dysfunction may influence the duration of antibiotic therapy 4, 5.
- The emergence of multidrug-resistant pathogens and the local pathogen patterns of resistance should be considered when choosing antimicrobials 4, 5.
- Individual antimicrobial optimization is essential to achieve adequate concentrations of antimicrobials, reduce adverse effects, and prevent the emergence of multidrug-resistant pathogens 4, 5.
Considerations for Antibiotic Stewardship
- Antimicrobial stewardship frameworks, leadership, and focus on the optimal duration of treatments, de-escalation, and novel diagnostic stewardship approaches can help improve patients' quality of care 4, 5.
- Regular review of the duration and adequacy of treatment is necessary to allow effective de-escalation and administration of short courses of antimicrobials for most patients 4, 5.
- The potential benefits and harms of shortening time-to-antibiotics for sepsis should be considered, including the risk of unnecessary antibiotic use and adverse events 6.