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.
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.
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.
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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