New Antibiotic Stewardship Guidelines

Slideshow

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  Preauthorization of broad-spectrum antibiotics and prospective review

  Preauthorization of broad-spectrum antibiotics and prospective review after two or three days of treatment should form the cornerstone of antibiotic stewardship programs to ensure the right drug is prescribed at the right time for the right diagnosis, according to recommendations included in the new guidelines

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  Improving patient outcomes

  Antibiotic stewardship programs save hospitals money, but their most important benefit is that they improve patient outcomes and reduce the emergence of antibiotic resistance.

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  Prospective audit

  Prospective audit allows antibiotic stewards to engage the prescribing clinician after the antibiotic has been used, typically after two or three days, to optimize antibiotic treatments.

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  Computerized clinical decision support

  Other recommendations include reducing the use of antibiotics associated with Clostridium difficile infection, implementing antibiotic time-outs, and other strategies to encourage prescribers to perform routine reviews using computerized clinical decision support if possible.

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  Preauthorization

  Providers need to get approval to use antibiotics before they are prescribed.

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  White House officials urge intervention.

  The White House has called for hospitals and healthcare systems to implement antibiotic stewardship programs by 2020 to ensure appropriate use of these vital drugs and reduce resistance.

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  Syndrome-specific interventions

  The guidelines recommend focused multifaceted interventions for the treatment of specific syndromes, rather than trying to improve treatment of all infections at once. For example, those leading a hospital’s antibiotic stewardship program might take a close look at management of pneumonia during winter, including making recommendations to shorten the amount of time people are treated and switching to an oral agent more quickly, and then measuring the results of those interventions. In the fall, the program might focus on another intervention, like that for urinary tract infections.

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  Rapid diagnostic testing

  The guidelines note that rapid diagnostic testing of respiratory specimens can help determine if the cause is viral and therefore reduce the inappropriate use of antibiotics.

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  Passive educational tools

  Lectures and brochures should be used to supplement strategies such as antibiotic preauthorization and prospective audit and feedback.

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  Antibiotic stewardship to benefit patients and healthcare systems

  It is key that these programs tailor interventions based on local issues, resources and expertise. To ensure that, the guidelines recommend the programs be led by physicians and pharmacists and rely on the expertise of infectious diseases specialists.