Antibiotic de-escalation in culture-negative healthcare-associated pneumonia

Abstract

The guidelines from the American Thoracic Society (ATS) and the Infectious Disease Society of America (IDSA) recommend "early, appropriate antibiotics inadequate doses, while avoiding excessive antibiotics by de-escalation of initial antibiotic therapy,based on microbiologic cultures and the clinical response of the patient, and shortening the duration of therapy to the minimum effective period"1. But they offer no recommendations on how to de-escalate when the cultures are negative. They do mention that if lower respiratory tract cultures obtained before antibiotics are negative at 48-72 hours, discontinuation of antibiotics can be considered. However, unless the patient is intubated (i.e. intensive care setting), we are usually unable to obtain lower respiratory tract cultures.