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Antibiotic use in the intensive care unit (ICU) presents unique challenges due to the high acuity and complexity of critically ill patients. Inappropriate use of antibiotics can contribute to the emergence of multidrug-resistant organisms, while underuse can lead to poor outcomes. Antimicrobial stewardship programs can assist in optimizing antibiotic use in the ICU, but implementation can be challenging. One approach to improving appropriate antibiotic use in the ICU is through prolonged infusions, which can be beneficial in populations with altered pharmacokinetics. Other strategies include de-escalation and targeted therapy based on culture results. This review highlights the current literature on antibiotic use in the ICU, including the challenges and opportunities for effective antimicrobial stewardship. Key considerations for appropriate use of antibiotics in the ICU include patient factors, pathogen susceptibility, and local resistance patterns. Ongoing efforts are needed to improve antibiotic prescribing practices in the ICU, with the goal of achieving optimal patient outcomes while minimizing the risk of antibiotic resistance.

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