Relevance of the initial empirical antibiotic prescription in the short-term prognosis of the infected patient

Dear Editor,

We have carefully read the comments and contributions made by Solis-Ovando et al.¹ and we agree with a number of the appraisals they make on our work regarding the inadequacy of antibiotic therapy.² However, we would like to make some comments.

Numerous studies have highlighted that the inadequacy of antibiotic therapy leads to increased mortality, including one by our own group.^3–5 However, these studies have been performed on patients with septic shock and severe sepsis, where decision-making is particularly important due to the severity of the process, which leads to a high mortality. Our study does not focus on these patient profiles. The population included in our work features patients who are complex enough to be admitted onto a conventional hospital ward, but whose conditions are not serious enough to require intensive care. Among this population profile, decision-making might not be so decisive that it has consequences on mortality, as shown by our results. However, it is possible that our study may not have sufficient power to find significant differences in short-term prognoses, due to the fact that the mortality of the series stands at 11%. We believe that new prospective studies on this less severely ill population profile are needed, where all of the factors that may influence the patient's clinical course and all the infection models are taken into account in order to determine the repercussion of an error during the selection of the initial empirical treatment.

Pending future studies, although the main objective when approaching the treatment of infected patients is clearly to improve survival, we must not disregard the importance of reducing the average hospital stay, in order to both reduce health-related costs and to lower the risk of saturating emergency departments.^6,7

Finally, we totally agree on the importance of implementing tools that assist decision-making as regards the selection of a treatment, including the PROA (antimicrobial use optimisation) programmes and the introduction of clinical guidelines. This is an area for improvement that is specifically recognised in the emergency sector^8,9 and significant efforts have been made to improve and standardise decisions.¹⁰

Funding

None declared.

Conflicts of interest

The authors declare that they have no conflicts of interest.