Empiric coverage
Formal Definition
Antimicrobial therapy initiated before culture and sensitivity results are available, based on the most likely pathogens for a given clinical syndrome, the patient's risk factors, local antibiogram data, and severity of illness; the goal is to cover the probable causative organism(s) while awaiting definitive microbiological data.
How It's Used on the Ward
"Starting empiric coverage" or "what are you covering empirically?" — the clinical decision of which broad antibiotic to start before you know what you're treating.
Example
""Community-acquired pneumonia in a 65-year-old with no recent hospitalization: starting empiric coverage with azithromycin plus a respiratory fluoroquinolone. If no improvement in 48 hours or cultures grow something resistant, we'll reassess.""
Clinical Context
Empiric selection should be guided by: infection syndrome (CAP vs HAP vs VAP), prior culture data, prior antibiotic exposures (resistance risk), local antibiogram, allergy history, renal/hepatic function. The risk of empiric therapy being too narrow (undertreating) must be balanced against the risk of overtreatment (Clostridioides difficile, resistance selection, adverse effects). CAP empiric: azithromycin ± beta-lactam or respiratory FQ. Sepsis/septic shock: broad spectrum (piperacillin-tazobactam or carbapenem ± vancomycin) then de-escalate.