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Fifteen-minute consultation: the complexities of empirical antibiotic selection for serious bacterial infections—a practical approach
  1. Julia A Bielicki1,2,3,
  2. David A Cromwell2,
  3. Mike Sharland1
  1. 1Paediatric Infectious Diseases Research Group, Infection and Immunity, St George's University of London, London, UK
  2. 2Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
  3. 3Paediatric Pharmacology Group, University of Basel Children's Hospital, Basel, Switzerland
  1. Correspondence to Dr Julia Anna Bielicki, Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's University of London, Cranmer Terrace, London SW17 0RE, UK; jbielick{at}


Potentially life-threatening infections require immediate antibiotic therapy. Most early stage antibiotic treatment for these infections is empirical, that is, covering a range of possible target bacteria while awaiting culture results. Empirical antibiotic regimens need to reflect the epidemiology of most likely causative bacteria, type of infection and patient risk factors. Summary data from relevant isolates in similar patients help to identify appropriate empirical regimens. At present, such data are mostly presented as hospital or other aggregate antibiograms, showing antimicrobial susceptibility testing results by bacterial species. However, a more suitable method is to calculate weighted incidence syndromic combination antibiograms for different types of infections and regimens, allowing head-to-head comparisons of empirical regimens. Once there is confirmatory or negative microbiological evidence of infection, empirical regimens should be adapted to the identified bacterial species and susceptibilities or discontinued.

  • Infectious Diseases
  • Microbiology
  • Therapeutics

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  • Contributors JAB wrote a first draft of the manuscript. DAC and MS critically reviewed and provided detailed feedback on the manuscript. All authors approved the final manuscript.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.