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Antibiotic stewardship de-escalation — RCPSC IM MCQ

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HardGeneral IM/Ethics/CanMEDSAntibiotic stewardship de-escalationRCPSC IM

A 67-year-old man was admitted with septic shock from pyelonephritis and started on meropenem and vancomycin. He is now stable, off vasopressors and afebrile. Blood and urine cultures grow susceptible Escherichia coli. There is no catheter infection or Gram-positive isolate. What is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Narrow antibiotics to a targeted agent active against the isolate

Once cultures and clinical response permit, antimicrobial therapy should be narrowed to reduce toxicity, resistance and C difficile risk.

Reference: AMMI Canada antimicrobial stewardship guidance; Royal College CanMEDS Leader role