If you've already launched an antimicrobial stewardship program, you likely know how effective a few simple interventions can be changing antibiotic use patterns in your hospital. You also probably know that there is so much more to be done. For your next steps, choose one of these five ways to improve your antimicrobial stewardship program, as recommended by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America.1
1. Institute dose optimization recommendations for specific infections. Many studies have found a drift toward longer durations of antibiotic therapy over time, though randomized clinical trials show that short courses of the right antibiotics can be just as effective and have fewer downsides in terms of promoting development of resistant organisms. Defining optimal daily dosage and days of therapy makes it easier for clinicians based on type of infection and patient characteristics, makes prescribing easier for physicians, simplifies conversations about appropriate prescribing practices, and reduces antibiotic overuse.
2. Implement automatic time-outs for empiric treatment unless confirmed by laboratory results in 48-72 hours. Many sick patients are prescribed antibiotics without clear evidence of bacterial infection. A forced break in administration:
- Keeps some patients from continuing to receive unneeded drugs
- Requires clinicians to review charts and patient condition to verify presence and type of infection in other cases
- Encourages reassessment and switching to a more appropriate and effective antibiotic in other instances
3. Prospectively audit antimicrobial prescriptions. Review prescriptions and communicate any issues directly and quickly to physicians, including unnecessary or inappropriate choice of antimicrobial, improper dosage or excessive duration. Monitor prescriptions for use of redundant medications in combination therapies and educate prescribers on the benefits of streamlining antibiotic use to minimize antimicrobial exposure.
4. Standardize conversions from IV to oral drug administration. Development of clear guidelines that outline when and for which antimicrobials conversion makes sense eases implementation. Switching to oral medications as soon as possible supports the antimicrobial stewardship program by reducing infections associated with catheter use; 70% of which are caused by multidrug resistant organisms.
5. Employ healthcare information technology such as electronic medical records and clinical decision support software to incorporate data from throughout the hospital, including laboratory and microbiology, and improve antimicrobial selection. Use computer-based surveillance technology to stay on top of healthcare-associated infections (HAIs) and quickly identify resistance patterns.
1. Dellit TH, Owens RC, McGowan JE, Gerding DN, Weinstein RA, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship. Clinical Infectious Diseases. 2007;44:159-77.