De-escalating Antibiotic Use in the Inpatient Setting: Strategies, Controversies, and Challenges

  • J. Daniel MarkleyEmail author
  • Shaina Bernard
  • Gonzalo Bearman
  • Michael P. Stevens
Healthcare Associated Infections (G Bearman and D Morgan, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Healthcare Associated Infections


Purpose of Review

Antibiotic de-escalation (ADE) is widely accepted as an integral strategy to curtail the global antibiotic resistance crisis. However, there is significant uncertainty regarding the ideal ADE strategy and its true impact on antibiotic resistance. Rapid diagnostic testing has the potential to enhance ADE strategies. Herein, we aim to discuss the current strategies, controversies, and challenges of ADE in the inpatient setting.

Recent Findings

A consensus definition of ADE remains elusive at this time. Preliminary studies utilizing rapid diagnostic tests including matrix-assisted laser desorption/ionization time of flight (MALDI-TOF), procalcitonin, and other molecular techniques have demonstrated the potential to support ADE strategies.


In the absence of evidence-based, highly specific ADE protocols, the likelihood that individual providers will make consistent, often challenging, decisions to de-escalate antibiotic therapy is low. Antimicrobial stewardship programs should support local physicians with ADE and develop innovative ways to integrate ADE into the broader construct of antimicrobial stewardship programs. The evolving field of rapid diagnostics has significant potential to improve ADE strategies, but more research is needed to fully realize this goal.


Antibiotic de-escalation Antimicrobial stewardship Resistance 


Compliance with Ethical Standards

Conflict of Interest

Drs Markley, Bernard, Bearman, Stevens declares no conflict of interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the author.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • J. Daniel Markley
    • 1
    Email author
  • Shaina Bernard
    • 2
  • Gonzalo Bearman
    • 1
  • Michael P. Stevens
    • 1
  1. 1.Department of Internal Medicine, Division of Infectious DiseasesVirginia Commonwealth University Medical CenterRichmondUSA
  2. 2.Department of PharmacyVirginia Commonwealth University Medical CenterRichmondUSA

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