What is the role of antibiotic therapy for systemic inflammatory response syndrome (SIRS)?

Updated: Nov 12, 2020
  • Author: Kamran Boka, MD, MS; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Empiric antibiotics are not indicated for all patients with systemic inflammatory response syndrome (SIRS). Indications for antibiotic therapy include the following:

  • Suspected or diagnosed infectious etiology (eg, urinary tract infection [UTI], pneumonia, cellulitis)

  • Hemodynamic instability

  • Neutropenia or other immunocompromised states

  • Asplenia - Due to the potential for overwhelming postsplenectomy infection (OPSI)

When feasible, culture specimens should always be obtained prior to initiating antibiotic therapy. Antibiotics administered prior to culturing may be a cause of sterile sepsis.

Empiric antibiotic therapy should be guided by available practice guidelines and knowledge of the local antibiogram, as well as the patient's risk factors for resistant pathogens and allergies. The key is to stop antibiotics when infection is ruled out or narrow the antibiotic spectrum once a pathogen is found.

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