Antibiotic Stewardship Reference
Definitions, preferred agents, and red flags for rational prescribing
These definitions are based on expert opinion and guideline-based criteria for assessing appropriateness of antimicrobial use. Source: Clin Infect Dis 2016;63(12):1639.
Inappropriate Use
Use of antimicrobials not recommended in treatment guidelines, OR use of antimicrobials to which the organism is resistant.
Examples:
- •Prescribing azithromycin for acute sinusitis (not guideline-recommended first-line)
- •Using amoxicillin for a known penicillin-resistant organism
- •Prescribing fluoroquinolones for uncomplicated UTI as first-line
Unnecessary Use
Use of antimicrobials for non-infectious disorders, non-bacterial infections, prolonged duration beyond clinical utility, or redundant therapy.
Examples:
- •Antibiotics for acute bronchitis (viral in >90% of cases)
- •Antibiotics for viral upper respiratory infection
- •Treating asymptomatic bacteriuria (except in pregnancy)
- •Continuing broad-spectrum therapy after culture identifies narrow-spectrum options
Suboptimal Use
Use of antimicrobials that could be improved in choice of drug, route of administration, or dosing.
Examples:
- •Using broad-spectrum when narrow-spectrum would suffice
- •IV antibiotics when oral bioavailability is adequate
- •Incorrect dosing for patient weight or renal function