From The Journal of Infectious Diseases and The British Medical Journal:

Sepsis mortality has improved following advancements in early recognition and standardized management, including emphasis on early administration of appropriate antimicrobials. However, guidance regarding antimicrobial duration in sepsis is surprisingly limited.

Decreased antibiotic exposure is associated with lower rates of antibiotic resistance development, Clostridioides difficile-associated disease, antibiotic-related toxicities, and health care costs.

The timely initiation of appropriate antibiotic therapy remains an uncontested hallmark of successful sepsis treatment. Studies have highlighted the value of appropriate empiric antibiotic choices in sepsis and their early initiation, especially in septic shock.

Key Points:

The current Surviving Sepsis Campaign (SSC) guideline makes a general recommendation that 7 to 10 days of antibiotic coverage is likely sufficient for most serious infections associated with sepsis and septic shock, although this course may be lengthened in some scenarios (eg, undrained foci of infection, Staphylococcus aureus bacteremia, and neutropenia) or shortened in others (eg, pyelonephritis and spontaneous bacterial peritonitis). The recommendation is graded as weak, with low-quality evidence.

In principle, the optimal duration of antibiotic therapy in sepsis would be one that maximizes clinical effectiveness while minimizing the antibiotic-associated risks.

Evidence suggests that monitoring biomarkers such as procalcitonin can reduce antibiotic duration in sepsis by one day, but the effectiveness in severe disease and in low resource settings is not known.

For severe covid-19, antibiotic stewardship remains important for critically ill patients with pneumonitis and sepsis who are commonly treated with broad spectrum antibiotics.

Clinicians should use their clinical judgments to consider the diagnostic evidence, signs of resolution or worsening of infection, and individual risk when making a decision about the choice and duration of antibiotic treatment.

Overview of Amoxicillin-Clavulanate

Since 2017, Amoxicillin-Clavulanate has been a mainstay antibiotic in emergency departments and general practices throughout the country.

It is a combination of two separate drugs: amoxicillin and clavulanic acid. Amoxicillin is a penicillin derivative and has a similar activity against both gram-positive and gram-negative bacteria. Furthermore, with the addition of clavulanic acid, the spectrum is increased to include beta-lactamase-producing strains as well as broadening the coverage to include other bacterial species.

This antibiotic has been indicated for Acute otitis media, Acute bacterial sinusitis, Endocarditis, Dental abscess, Community-acquired pneumonia, Acute uncomplicated UTI, Uncomplicated gonorrhea and Severe or recurrent respiratory tract infections.

This property triggered 3.4% increase per annual use with highest inter-professional practice in the GPs, internal medicine, pediatric and surgery, dental, nephrology, oncology, orthopedic and diabetology.