ICU Antibiotic Use: Step-by-Step

1. Identify Infection

Confirm clinical suspicion of infection

Obtain appropriate cultures before antibiotics

Do not delay treatment in sepsis or septic shock

CRP and PCT may support diagnosis but are not definitive

Rapid test may aid early pathogen identification

2. Start Empirical Antimicrobial Therapy

Base choice on:
- Local ICU antibiogram
- Site of infection
- Community vs hospital-acquired infection
- Recent antibiotic exposure
Avoid unnecessary broad-spectrum antibiotics

3. Timing of Antibiotics

4. Dose Optimisation

Individualise dose based on:
- Renal function
- Body weight
- Organ dysfunction
- Pharmacokinetic / pharmacodynamic properties

5. Review and De-escalation (24–72 hours)

Review:
- Culture and sensitivity results
- Clinical response
Actions:
- De-escalate therapy
- Narrow antibiotic spectrum
- Stop antibiotics if infection unlikely
- Optimise duration

Antibiotic Guidelines