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April 2016
IDSA and SHEA Release New Guideline on Antibiotic Stewardship
New guidelines on antibiotic stewardship are now available from IDSA and the Society for Healthcare Epidemiology of America (SHEA). Published in Clinical Infectious Diseases, the guidelines provide recommendations to ensure antibiotic stewardship programs are most effective in reducing the emergence of antibiotic resistance, including that they be led by ID physicians and pharmacists, who have the expertise and education to ensure the right drug is being prescribed at the right time for the right diagnosis. 
Preauthorization of broad-spectrum antibiotics and prospective review after two to three days of treatment should be the cornerstone of antibiotic stewardship programs, according the new guideline. Additional recommendations include using syndrome-specific interventions over attempting to improve all infections at once, and the use of rapid diagnostic testing to determine if the cause is viral, thereby reducing the inappropriate use of antibiotics. 
The guidelines also call for reduction of the use of antibiotics associated with high risk of development of Clostridium difficile disease, implementation of antibiotic time-outs and other strategies to encourage prescribers to perform routine reviews of regimens, and the use of computerized clinical decision support where possible. 
Passive educational materials are insufficient in implementing antibiotic stewardship programs, according the guideline recommendations, because improvement is unlikely to be sustained. Lectures and brochures should be used to supplement strategies such as preauthorization and prospective audit and feedback. 
The new guideline is available in mobile and pocketcard versions. 
Co-authors of the guideline are Tamar Barlam, MD, FIDSA, FSHEA of Boston Medical Center and Sara Cosgrove, MD, FIDSA, FSHEA of Johns Hopkins University. Additional members of the guideline panel include: Lilian Abbo, MD, FIDSA; Conan MacDougall, MD; Audrey N. Schuetz, MD; Ed Septimus, MD, FIDSA, FSHEA; Arjun Srinivasan, MD, FSHEA; Timothy Dellit, MD; Yngve T. Falck-Ytter, MD; Neil Fishman, MD, FSHEA; Cindy W. Hamilton, MD; Timothy C. Jenkins, MD; Pamela A. Lipsett, MD; Preeti N. Malani, MD, FIDSA, FSHEA; Larissa S. May, MD; Gregory J. Moran, MD, FIDSA; Melinda M. Neuhauser, MD; Jason Newland, MD; Christopher A. Ohl, MD, FIDSA; Matthew Samore, MD, FSHEA; Susan Seo, MD, FIDSA; and Kavita K. Trivedi, MD.

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