Put an antibiotic review on the calendar at 48 to 72 hours

Empirical broad-spectrum antibiotics are started on uncertainty; the review at 48 to 72 hours is where that uncertainty should resolve. By then cultures, susceptibilities and the clinical trajectory usually allow a decision: stop if infection is unlikely, narrow to the organism, and set a definite stop date rather than an open-ended course.

Make the review an explicit step, documented, not something left to the next team to notice. Streamlining to a narrower agent and the shortest effective duration reduces resistance, Clostridioides difficile and drug toxicity without worsening outcomes for most infections.

• Diarise an antibiotic review at 48 to 72 hours for every empirical start.
• Use cultures, susceptibilities and trajectory to stop, narrow or set a stop date.
• Prefer the narrowest effective agent and the shortest effective duration.
• Document the decision so the next team does not simply continue by default.

Why it matters

The biggest avoidable driver of resistance and C. difficile is empirical antibiotics continued past the point of uncertainty.

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