HARD DECISIONS IN INTENSIVE CARE UNIT

Intensivecareunitkapak

ANTIBIOTIC SELECTION AND PROPER USE

Ayşe Gül Çeliksu

Ankara Bilkent City Hospital, Department of Intensive Care, Ankara, Türkiye

Çeliksu AG. Antibiotic Selection and Proper Use. In: Turan S, editor. Hard Decisions in Intensive Care Unit. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.365-376.

ABSTRACT

Selecting antibiotics in the intensive care unit (ICU) is crucial for patients in life-threatening conditions, requiring careful consideration of multiple factors. First, the most appropriate empiric antimicrobial treatment should be initiated rapidly by accurately assessing the source, nature and severity of the infection, supported by the patient’s clinical status, laboratory values and imaging results. The selection and use of antibiotics may differ between critically ill patients and normal patients. The selection of suitable empirical antibiotics should be based on the critical patient’s condition, the nature of the infection, and the ICU. Factors such as the patient’s general condition, age and comorbidities are also important in the selection of appropriate antibiotics; for example, antibiotic selection may be different and dosage adjustments may be necessary for patients with impaired renal function. Common pathogens in the ICU include resistant bacteria such as Pseudomonas aeruginosa and MRSA; therefore, the local microbial flora and previous culture results should also be considered. Antibiotic treatment should be initiated promptly, while limiting broad-spectrum antibiotics because unnecessary use increases antibiotic resistance. The treatment duration should be adjusted based on the infection type and the patient’s clinical response; for instance, 7-10 days is typically enough to treat pneumonia, whereas bacterial sepsis may require longer treatment. Attention to side effects is also important; as antibiotics can have nephrotoxic and hepatotoxic effects, regular laboratory monitoring should be carried out and treatment modified if necessary. Antibiotic stewardship programs are essential to optimize antibiotic use and reduce the development of resistance; these programs are developed in collaboration with healthcare professionals and with effective surveillance and education strategies. In conclusion, the use of antibiotics in intensive care requires a multidisciplinary approach. Proper selection and use of antibiotics are crucial for enhancing patient safety , ensure successful infection management and prevent the development of resistance.

Keywords: Intensive Care; Infections; Treatment; Antibiotics; Optimal use

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