Sepsis and antibiotics: When should we deploy a parachute?

In sepsis and septic shock, guidelines recommend administering antimicrobial therapy within the first hour following diagnosis. This recommendation is based on observational studies suggesting that early antimicrobial therapy is associated with improved outcomes. Consequently, front-line physicians are under pressure to quickly decide on the need for antibiotics in patients for whom the diagnosis of sepsis remains uncertain. However, overuse of antibiotics is associated with emergence of multidrug-resistant bacteria, which constitutes a major health issue worldwide. Front-line physicians may be thought to have been responsible for antibiotic overuse in the same patients. This article reports the situation of physicians who are criticised for using unnecessarily antibiotics or those who are criticised for not timeously using antibiotics; it then discusses several options to help the clinician at the bedside.