Irrational use of antibiotics without a clinical diagnosis: a short case report.

Antibiotics are often started irrationally and continued injudiciously worldwide without a clinical diagnosis. Antibiotic prescription practises are governed by multiple factors like lack of diagnostic facilities, secondary infections, poor sanitary conditions, easy availability, pharmaceutical companies' marketing strategies and patients seeking the fastest cure from healthcare providers. We report a case of a 40-year-old male who was treated intermittently with multiple antibiotics for 3 months without being clinically diagnosed. The patient continued having episodes of fever with brief periods of remission. The occurrence of recurrent episodes of transient ischemic attacks alarmed him, and he was brought to a tertiary hospital, where a diagnosis of culture-negative Infective Endocarditis (IE) was made. He underwent successful high-risk double valve replacement and was discharged from the hospital in satisfactory condition. Key messages: Antibiotics should be started judiciously with a proper clinical indication and should be reviewed from time to time regarding selection, duration, and response. In the case of non-responders, a thorough clinical examination followed by relevant investigations should be done for a proper clinical diagnosis.