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Knowing when to stop antibiotic therapy

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Empirical antibiotic therapy that turns out to be unnecessary, on review, can (and should) be stopped immediately

After 50 years of widespread antibiotic use, we have reached the point where experts are seriously predicting “a postantibiotic era” and the World Health Organization has declared antibiotic resistance “a threat to global security”.1 No one can doubt the enormous benefits of antibiotics in curing or preventing serious sequelae of infections that were once the main causes of death and chronic illness, and enabling modern medical therapies that involve significant immune suppression.

These benefits are dramatic, and toxic side effects are apparently few. This makes it tempting — even now, when we know the risks — to prescribe antibiotics empirically at the first hint of infection, even viral infection,2 lest it progress to serious sepsis (and potential medicolegal or professional embarrassment3). Although unnecessary antibiotic use is sometimes driven by patients’ expectations, they can be modified by public education.4

During the first 30 years of the antibiotic era, the release of each new antibiotic was almost always followed by the emergence of resistance in some previously susceptible bacteria, but there were always new antibiotics…