What Is Empiric Therapy?

Empiric therapy is the provision of treatment in the absence of a diagnosis. This may be advised when it is critical to get a patient into treatment quickly to prevent complications, or when the time and expense associated with treatment are impractical. In a classic example, if a patient reports to a doctor with symptoms of a urinary tract infection like frequent, painful urination, the doctor often prescribes antibiotics immediately. The treatment is given even though the patient’s infection has not been definitively diagnosed.

Antibiotics are a common choice for empiric therapy, for a number of reasons. One concern with patients who are severely ill is that they could quickly become worse if doctors wait on treatment until testing confirms the diagnosis, and determines which antibiotic is appropriate. Someone at severe risk for complications might need antibiotics immediately, without waiting. The doctor can request testing to check, and may adjust the treatment if necessary, depending on the test results.

Another issue is that detailed diagnosis can be expensive, and not always necessary. A patient’s urinary tract infection, for example, may respond very well to broad spectrum antibiotics designed to target a number of organisms. The patient wouldn’t need an expensive urine collection and culture to confirm the presence of infection and determine which drug to use. If the patient does not respond to empiric therapy, then the doctor can move on to diagnostic testing, since the failure of response is a clear indicator that something else is going on or that the patient is infected with a resistant organism.

Doctors determine whether a patient could benefit from empiric therapy on the basis of reported symptoms and experience. In addition to treating patients preemptively for common conditions that may not require testing, doctors can also consider individual patient history. Someone with a repeat history of urinary tract infections might not need detailed testing every time, because it’s a known issue. This patient might even receive a standing prescription for antibiotics to start taking right away at the first sign of symptoms.

Medical protocols to determine whether empiric therapy is appropriate are in place at some facilities. One concern is that patients may receive unnecessary medications which could contribute to issues like the development of antibiotic resistance. The haste to assume a problem is the result of a common issue that doesn’t require diagnostic testing might also mean that a diagnosis is missed. Frequent painful urination, for example, could be a sexually transmitted infection or sign of a urinary cancer.