- Approaches to optimize the use of both existing antibiotics and newly developed antibiotics are of critical importance to ensure that we continue to reap their benefits and provide the best care to patients.
- Antibiotic stewardship has been defined as “coordinated interventions designed to improve and measure the appropriate use of antibiotic agents by promoting the selection of the optimal antibiotic drug regimen including dosing, duration of therapy, and route of administration.”
- The benefits of antibiotic stewardship include improved patient outcomes, reduced adverse events including Clostridium difficile infection (CDI), improvement in rates of antibiotic susceptibilities to targeted antibiotics, and optimization of resource utilization across the continuum of care.
- IDSA and SHEA strongly believe that antibiotic stewardship programs are best led by infectious disease physicians with additional stewardship training.
- We recommend preauthorization and/or prospective audit and feedback over no such interventions (See Table 1) (S-M).
- Preauthorization and/or prospective audit and feedback improve antibiotic use and are a core component of any stewardship program. Programs should decide whether to include one or a combination of both strategies based on the availability of facility-specific resources for consistent implementation, but some implementation is essential.
- We suggest against relying solely on didactic educational materials for stewardship (W-L).
- Passive educational activities, such as lectures or informational pamphlets, should be used to complement other stewardship activities. Academic medical centers and teaching hospitals should integrate education on fundamental antibiotic stewardship principles into their preclinical and clinical curricula.
- We suggest antibiotic stewardship programs (ASPs) develop facility-specific clinical practice guidelines coupled with a dissemination and implementation strategy (W-L).
- Facility-specific clinical practice guidelines and algorithms can be an effective way to standardize prescribing practices based on local epidemiology. ASPs should be involved in writing clinical pathways, guidelines, and order sets that address antibiotic use and are developed within other departments at their facility.
- We suggest ASPs implement interventions to improve antibiotic use and clinical outcomes that target patients with specific infectious diseases syndromes (W-L).
- ASP interventions for patients with specific infectious diseases syndromes—such as community-acquired pneumonia, skin and soft tissue infection, and urinary tract infection—can be an effective way to improve prescribing because the message can be focused, clinical guidelines and algorithms reinforced, and sustainability improved.
- We recommend antibiotic stewardship interventions designed to reduce the use of antibiotics associated with a high risk of Clostridium difficile infection, compared with no such intervention (S-M).
- The goal of reducing CDI is a high priority for all ASPs and should be taken into consideration when crafting stewardship interventions.
- We suggest the use of strategies (e.g., antibiotic time-outs, stop orders) to encourage prescribers to perform routine review of antibiotic regimens to improve antibiotic prescribing (W-L).
- Successful prescriber-led programs appear to require a methodology that includes persuasive or enforced prompting.
- We suggest incorporation of computerized clinical decision support at the time of prescribing into ASPs (W-M).
- Computerized clinical decision support for prescribers should only be implemented if information technology (IT) resources are readily available. However, computerized surveillance systems can streamline the work of ASPs by identifying opportunities for interventions.
- We suggest against the use of antibiotic cycling as a stewardship strategy (W-L).
Table 1. Comparison of Preauthorization and Prospective Audit and Feedback Strategies for Antibiotic Stewardship
|Preauthorization||Prospective Audit and Feedback|