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In case of ongoing clinical and/or radiological disease activity and/ or relevant side effects, an escalation therapy can be initiated.
Results: Eight hundred and fifty two patients were enrolled and de escalation therapy was performed on two hundred and sixty seven (31,3 %).
The frequency of de-escalation (51% in B+ vs 55% in B- pts) and escalation therapy (19% vs 25%, respectively) was similar in both groups.
In general, patients with ≥1 relapse per year, absence of complete recovery from relapses, sustained disability progression of ≥1 and MRI progression, with or without clinical signs, are considered as 'treatment non-responders', justifying the transition from basic to escalation therapy [9].
On the other hand, an escalation therapy is a more risky short-term option at the individual level.
Finally the EASD guidance is less specific in guiding escalation therapy, but states that metformin usually is the treatment option of choice for both mono- and combination therapy, including insulin [ 14].
Similar(52)
First-line basic therapy is distinguished from second-line escalation therapies.
Among the 95 patients in whom the antibiotics could be de-escalated, based on the antimicrobial susceptibility data, 32 patients (33.7%) received de-escalation therapy.
Conclusions: De-escalation therapy for septic critically ill patients is a safe strategy associated with a lower mortality.
Blood cultures possitives, microbiological documentation and combination of antibiotic therapy were independent factors associated with de-escalation therapy.
Objective: The aim of this study was to evaluate factors associated with no de-escalation therapy in a cohort of patients admitted to the ICU with severe sepsis.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com