Q: On which day after initiation of empiric antibiotic therapy, de-escalation should be considered?

Answer:  3 - 5 days

For patients who have suspicion of infection, early and appropriate therapy - and probably aggressive empirical therapy - is required at the first sign of infection. Although, the initial choice of antimicrobial therapy is critical to the clinical outcomes of patients, it is also imperative to start de-escalation of antibiotics therapy as emerging data is showing benefit in mortality rate, or at least no worse outcome.

De-escalation therapy based on APACHE II score can be safely applied with good clinical outcomes, even in those patients with negative cultures.