De-escalation

Definition:

Change from a broad-spectrum antimicrobial to a narrower spectrum drug or change from combination therapy to monotherapy.

Treatment of suspected serious life-threatening infections, such as bloodstream infections in patients with sepsis, is often started without confirmation of the infection or identification of the responsible organism. This leads to the use of broad-spectrum antibiotics or combinations of antibiotics. When microbiological diagnostic information becomes available, clinicians may be able to safely switch to more specific treatments and/or discontinue use of certain antibiotics.

Antibiotic de-escalation is a key element of antimicrobial stewardship programmes. Reduced use of broad-spectrum or unnecessary antibiotics lowers the selection pressures that drive the development of resistance. It also reduces patients’ risk of adverse reactions to antibiotics.

In practice, de-escalation can be challenging as clinicians may be reluctant to halt treatment if a patient seems to be responding.