1. Rational empiric antibiotic therapy in clinical practice and policy making: uncertainties, probabilities, and ethics
- Author
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Lambregts, M.M.C., Visser, L.G., Boer, M.G.J. de, Kuijper, E.J., Fijter, J.W. de, Verbon, A., Wiersinga, W.J., and Leiden University
- Subjects
Ethics ,Sepsis ,Bacteraemia ,Antimicrobial stewardship ,Antimicrobial resistance ,Empirical therapy ,Clinical decision making - Abstract
A significant proportion of the in-hospital antimicrobial consumption is used in the empiric setting, making empiric therapy an important target of stewardship interventions.Empiric antimicrobial therapy is the antimicrobial regimen that is started when the definite clinical diagnosis, causative agent and/or resistance pattern are yet unknown. Empiric therapy is accompanied by a varying level of uncertainty. In daily clinical practice, this uncertainty about the source, pathogen and susceptibility pattern are often managed by prescribing relatively broad-spectrum antimicrobial therapy. This has potential negative effects, such as toxicity and selective pressure resulting in antimicrobial resistance. Balancing the potential benefits and drawbacks of more broad-spectrum therapy is a substantial challenge, in particular when the level of uncertainty is high.This thesis aims to address the uncertainties most relevant in daily clinical practice in empiric antimicrobial therapy, to determine how they affect daily decision making, and to explore how this can be translated in antimicrobial policy making and antimicrobial stewardship.
- Published
- 2021