Culture results are the only way to turn empirical therapy into targeted therapy, and the chance is lost once antibiotics have been given. In a patient who is unwell, draw blood cultures from two sites and send urine and any other relevant sample, then start antibiotics without waiting for results.
At 48 to 72 hours, review the result. Narrow therapy when an organism and susceptibility are known, stop it if there is no infection, and set a duration. Local resistance patterns, not national or foreign figures, decide the empirical choice.
- Take blood cultures from two sites before antibiotics when this does not delay treatment in a septic patient.
- Send urine, sputum or wound samples as the source suggests.
- Record a review time and an intended duration in the notes at the start.
- Narrow or stop at 48 to 72 hours according to results.
Why it matters
Antibiotic review at 48 to 72 hours is where stewardship is won or lost.
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