Antibiotic Stewardship

Question 1

• What is de-escalation?

• when does it happen?

Answer 1

If a patient is on broad spectrum drugs, de-escalation is when you give a narrower spectrum drug once you know more about their infection. This often happens 24-48 hours after admission, once cultures might have come back, for example.

Question 2

• How should you be treating people on antibiotics in general?

Answer 2

o Start on broad spectrum if you suspect an infection and it is urgent
o Review diagnosis after 48-72 hours, once you have culture information
o Then you can either:
i. Stop treatment (if there’s no evidence of infection)
ii. Switch IV to oral antibiotics
iii. Change to a narrower spectrum

Question 3

• What are the features of penicillin allergy?

Answer 3

1. Urticaria (raised, red, itchy bumps)
2. Angioedema
3. Anaphylaxis (rare)

Question 4

• What conditions are urgent and require antibiotics before you’re even sure of the diagnosis?

Answer 4

Septic shock and meningitis