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Introduction

Antibiotics are a double-edged sword . They have saved probably millions of lives since their introduction to medicine . However , antibiotics can cause toxicity , potential harmful drug – drug interactions and can severely disturb the microbiome .

Over the last decades , we have learned that if antibiotic therapy is used when it is not indicated or if it is used for too long or too broadly , then we not only select for resistance but may also increase mortality .

This causes a clinical dilemma : if we withhold antibiotics , or if we do not target the underlying pathogen , we put patients at risk – particularly in sepsis . On the other

hand , data show that non-specific rapid administration of broad-spectrum antibiotics increases mortality . The ideal approach is early targeted treatment .

However , that is not possible in many patients because the underlying pathogen cannot be identified , particularly during the first couple of days of infection .

The solution to this problem is called “ antibiotic stewardship ” ( ABS ). ABS can be understood as a quality management tool for antibiotic prescription and administration and includes a regular and structured evaluation of antibiotic treatment . ABS includes two levels : a general hospitalbased level , i . e . implementation of an ABS program , and an individual patient-center . �

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