Î 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 epidemiolog y. 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.
Î 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.
Î 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.
Î 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 methodolog y that includes
persuasive or enforced prompting.
Î 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 technolog y (IT) resources are readily available.
However, computerized surveillance systems can streamline the work of ASPs by
identifying opportunities for interventions.
Î We suggest against the use of antibiotic cycling as a stewardship
strategy (W-L).
Interventions
