Table 3.

Possible strategies for de-escalation in BSIs.

Pathogen	Antimicrobial options
MSSA or MSSE	Oxacillin (12-16 g every 24 h c.i.) or cefazolin (2-4 g every 8 h c.i)
Streptococci	Ampicillin (2 g every 4 h c.i.) or ceftriaxone (2 g every 24 h)
Enterococcus faecalis	Ampicillin (2 g every 4 h c.i.)
Non-ESBL Enterobacteriacae	Ceftriaxone (2 g every 24 h)
ESBL-Enterobacteriacae	Ertapenem (500 mg every 6 h, e.i. 4 h) )
Susceptible P.aeruginosa	Piperacillin-tazobactam (4.5 g loading dose, then 18g q 24h c.i.) or antipseudomonal cephalosporin (ceftazidime 6 g every 24 h, c.i.or cefepime 6 g every 24 hours, c.i.)
Fluconazole-susceptible Candida spp	Fluconazole (loading dose 12 mg/kg every 12 h, then 400 mg every 24 h)

Notes. MSSA: methicillin-susceptible Staphylococcus aureus

MSSE: methicillin-susceptible Staphylococcus epidermidis