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October 9, 2018

Antibiotics for Sepsis—Finding the Equilibrium

Author Affiliations
  • 1Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
  • 2Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
  • 3Infectious Diseases Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
  • 4Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom
JAMA. 2018;320(14):1433-1434. doi:10.1001/jama.2018.12179

Sepsis is medicine’s last remaining preserve for unrestrained antibiotic prescribing. The Surviving Sepsis Campaign guidelines recommend empirical broad-spectrum therapy within one hour of triage for both sepsis and septic shock.1 This recommendation, and mandates that compel it, encourage clinicians to adopt an approach of “treat first, ask questions later” for patients with any possibility of serious infection. This approach fails to account for the difficulties clinicians face with diagnosing infection, especially when patients initially present to care, and the high rate of overdiagnosis of sepsis, and thus risks promoting excess antibiotic use and causing unintended harm.

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