What are the principles of antibiotic use in the treatment of septic shock?

In the treatment of septic shock, antibiotic use should follow principles including early and adequate administration, targeted drug selection, combination therapy when necessary, appropriate duration of treatment, and dynamic evaluation and adjustment, in order to effectively control infection and improve prognosis. A detailed analysis is as follows:

1. Early and adequate administration: Antibiotic therapy should be initiated within one hour after diagnosis of septic shock to prevent disease deterioration due to spreading infection. The dosage must be sufficient—consideration should be given both to drug concentration at the site of infection and to the patient's liver and kidney function, ensuring that effective bactericidal concentrations are rapidly achieved to promptly suppress pathogen replication.

2. Targeted drug selection: Before obtaining results of microbiological testing and antimicrobial susceptibility, empirical antibiotic selection can be based on the source of infection and common types of pathogens. Once the causative organism is identified, antibiotics should be promptly switched to those to which the pathogen is susceptible, reducing the development of resistance and improving treatment precision.

3. Combination therapy when necessary: For infections caused by multidrug-resistant organisms, mixed infections, or severe infections not easily controlled by a single antibiotic, two or more antibiotics with different mechanisms of action may be used in combination. When combining drugs, potential interactions must be carefully considered to avoid antagonism or increased toxicity and adverse effects.

4. Appropriate duration of treatment: Treatment duration should be determined based on infection control status, type of pathogen, and the patient’s recovery progress, typically lasting 7 to 10 days. Premature discontinuation should be avoided to prevent recurrence, while excessively prolonged use should also be avoided to reduce risks of secondary infections or emergence of resistance.

5. Dynamic evaluation and adjustment: During treatment, close monitoring of body temperature, complete blood count, procalcitonin, and other indicators is required, along with assessment of clinical symptoms to evaluate therapeutic response. If no improvement is observed within 48 to 72 hours, the site of infection and possible pathogens should be re-evaluated, and antibiotic choice or dosage adjusted promptly.

In clinical practice, these principles should be flexibly applied according to individual patient conditions, while enhanced infection prevention and control measures are implemented to reduce the risk of complications.