• Kerina J Denny, Menino O Cotta, Suzanne L Parker, Jason A Roberts, and Jeffrey Lipman.
• a Department of Intensive Care Medicine , Royal Brisbane and Women's Hospital , Brisbane , Australia.
• Expert Opin Drug Saf. 2016 May 1; 15 (5): 667-78.

IntroductionThe altered pathophysiology in critically ill patients presents a unique challenge in both the diagnosis of infection and the appropriate prescription of antibiotics. In this context, the importance of effective and timely treatment needs to be weighed against the individual and community harms associated with antibiotic collateral damage and antibiotic resistance.Areas CoveredWe evaluate the principles of antibiotic use in critically ill patients, including dose optimisation, use of combination antibiotic therapy, therapeutic drug monitoring, appropriate antibiotic therapy duration, de-escalation, and utilisation of sepsis biomarkers. We also describe the potential risks associated with antibiotic therapy including antibiotic resistance, delayed treatment, treatment failure, and collateral damage.Expert OpinionPrescribing teams must be aware of the impact of critical illness on their patients and tailor antibiotic therapy appropriately to prevent the significant harms associated with suboptimal antibiotic administration.

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