Antibiotic de-escalation

Crit Care Clin. 2011 Jan;27(1):149-62. doi: 10.1016/j.ccc.2010.09.009.


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.

Publication types

  • Review

MeSH terms

  • Anti-Infective Agents / administration & dosage*
  • Cross Infection / drug therapy*
  • Drug Administration Schedule
  • Drug Resistance, Microbial
  • Humans
  • Intensive Care Units
  • Practice Guidelines as Topic
  • Sepsis / drug therapy*


  • Anti-Infective Agents