GENERAL PRINCIPLES
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Empirical Therapy – Antibiotic treatment is considered empirical when it is administered in the absence of microbiological confirmation or while awaiting pending reports. Reevaluation of empirical antibiotics must be conducted after 48-72 hours and once the reports become available.
Important considerations
Determine if antibiotic therapy is necessary. Discontinue if the cause is determined to be non-infectious. Seek assistance from the Antimicrobial Stewardship (AMS) team within the institution, if available.
Evaluate the possibility of using a narrow-spectrum antibiotic based on the reports. Consider de-escalating the antibiotics based on the clinical condition and available reports.
- Assess if switching to monotherapy is appropriate (if initially using a combination).
- Evaluate the feasibility of changing the route of administration to oral.
- Adjust the dosage based on renal and hepatic functions, if necessary.
- Check for potential drug interactions with other medications being used.
- Determine if any laboratory parameters need monitoring during therapy.
These recommendations serve as a treatment guide and do not replace the clinical judgment of the responsible physician after a comprehensive assessment of each individual case.
Prescriptions should clearly include
- Indication for antibiotic use.
- Formulation; Capsule/Tablet or Injection.
- Route of administration (e.g., IM or IV), infusion rate for IV, and dosing.
- Start date, review date, stop date, or duration.
Consider implementing transmission-based precautions and isolation for patients with infectious diseases and drug-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), drug-resistant tuberculosis (DRTB), Clostridioides difficile, etc.
Precautions to observe
Standard precautions: Practice proper hand hygiene, respiratory hygiene, sharps safety, safe injection practices, use sterile instruments and devices, maintain clean and disinfected environmental surfaces, and use gloves and protective clothings. Use mouth, nose, and eye protection during procedures.
Contact precautions: Ensure appropriate patient placement, limit patient transport, use disposable or dedicated equipment, perform cleaning and disinfection of the room, and use gloves gown.
Droplet precautions: Have patients wear masks for source control, ensure appropriate patient placement, limit patient transport, and provide masks for healthcare personnel.
Airborne precautions: Ensure patients wear masks for source control, place them in isolation rooms, limit patient transport, restrict susceptible healthcare personnel from entering the room, and have healthcare personnel wear N-95 masks or higher level respirators.
Please note that these precautions are subject to local guidelines and protocols and may require additional measures based on the specific circumstances.