The right empirical treatment

Treatment of severe infections and nosocomial infections needs prompt management as soon as possible and they must be based on an accurate strategy of treating what you know. The best technique to identify the germ you are dealing with is through culture. However, laboratory settings in different hospitals do not have a culture. Even if you can do culture, you need to treat it as soon as possible while you are waiting for the results for 3-7 days. This is where empirical therapy plays a role.

Empiric therapy is directed to an anticipated and the most likely cause of the infection as you wait to know the exact germ causing the infection, and it should consider:

• The localization/site of the infection: intravascular catheter-associated bacteremia is mostly a result of colonization and infection caused by staphylococci present on the skin.
• Epidemiological data of the probable etiology: Consult the most recent data in your settings regarding the most common disease etiologies.
• Sensitivity according to local epidemiology: Local bacterial resistance pattern; some hospitals have antibiograms for important pathogens.
• Distribution of the antibiotic (pharmacokinetics)
• What is the possible type of microorganism?
• Host clinical status (immunocompetent or immunocompromised): immunocompromised hosts can have trouble clearing infection and manifesting signs and symptoms of infection as well. 
  

To decrease the likelihood of resistance development in empirical treatment, the de-escalation approach is used in some settings. De-escalation mainly refers to reducing the spectrum of antibiotics administered by discontinuing antibiotics or switching to a narrower spectrum medication. However, there are few specific reports on the use of de-escalation treatment.