[Emergency antibiotic therapy in the adult]

Few studies have shown a direct relationship between the timing of antibiotic therapy and the outcome. In severe infections, the outcome is mainly dependent of virulence of the pathogen, and host susceptibility. Indeed, in some individuals, an enhanced inflammatory response may lead to multiple organ failure despite early and appropriate use of antibiotics. In critically-ill patients, antibiotic treatment should be associated with optimisation of oxygen delivery and with source control. Before deciding to administer antibiotics, the physician should try to classify the patient according to the degree of urgency to start the treatment. True emergencies are limited to fulminant meningococcemia and to infection in splenectomized patients. In other cases, careful analysis of patient's history and clinical examination are important steps to decide if antibiotic treatment should be given rapidly or may be delayed. The initial antibiotic regimen should be re-evaluated on day 3.