Title : Duration of antibiotic therapy in intensive care
Abstract:
Introduction: Antibiotics are the most widely prescribed drugs. Despite their many benefits, inappropriate use is not without risks. It is associated with the emergence of multidrug-resistant organisms, harmful effects on patients, and increased healthcare costs.
As part of the rationalization of antibiotic prescriptions—known as “antibiotic stewardship”—treatment duration is one of the main factors to be studied and monitored in order to minimize the risks linked to inappropriate antibiotic use.
Materials and Methods: We conducted a prospective study over one year, from January 1, 2022, to December 31, 2022, in the Surgical Emergency Intensive Care Unit “P33.”
The study included 226 patients who received antibiotic therapy for 72 hours or more for various types of infections.
Results:
- The median duration of treatment for respiratory infections was 6 days (5–9).
- For bacteremia, the median duration was 7 days (6–10).
- For intra-abdominal and urinary infections, it was 5 days (4–7).
- The median length of stay in the ICU was 8 days.
The overall mortality rate in this cohort was 31%, with:
- 47.8% in respiratory infections,
- 28.5% in bacteremia,
- 25% in urinary and intra-abdominal infections.
Most studies recommend the use of empirical antibiotic therapy while awaiting bacteriological results, whereas others support a “wait and watch” strategy to shorten treatment duration. However, this approach should be used with caution in unstable patients, immunocompromised individuals, or those in septic shock.
The appropriate choice of empirical antibiotic therapy remains central to the management of bacterial infections in intensive care. Its success relies on knowledge of the specific bacterial ecology of each unit and the local resistance rates of circulating pathogens.
The role of biomarkers, particularly procalcitonin (PCT), as a tool for antibiotic management—especially in guiding treatment discontinuation—has been studied in several trials. Evidence supports its effectiveness in reducing antibiotic duration, lowering mortality rates, and shortening ICU stays. Thus, it could be a valuable tool in the pursuit of individualized antibiotic therapy.
Conclusion: There is growing evidence supporting the use of short-course antibiotic regimens for the treatment of various infections, with clinical outcomes comparable to those achieved with longer courses.
