New Antibiotic Stewardship Guidelines Released from IDSA and SHEA

New antibiotic stewardship guidelines have been released by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) and published in Clinical Infectious Diseases (2016; doi: 10.1093/cid/ciw118).

The new guidelines replace those originally created to help with the development of programs when antibiotic stewardship was in its infancy and, instead, focus on specific strategies that the evidence suggests are most beneficial to ensure the program will be effective and sustainable. They also note it is key that these programs tailor interventions based on local issues, resources, and expertise. 

According to the guidelines, 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. The guidelines were prepared by a multidisciplinary expert panel made up of ISDA and SHEA clinicians and investigators representing internal medicine, emergency medicine, microbiology, critical care, surgery, epidemiology, pharmacy, and adult and pediatric infectious disease specialties.

Tamar Barlam, MD, lead co-author of the guidelines and director of the antibiotic stewardship program at Boston Medical Center (Boston, MA), said, “Initially, antibiotic stewardship was more focused on cost savings, and physicians responded negatively to that, because they often felt it was best to give patients the newest, most expensive drug, [but] their most important benefit is that they improve patient outcomes and reduce the emergence of antibiotic resistance.” 

The White House has called for hospitals and health care systems to implement antibiotic stewardship programs by 2020 to ensure appropriate use of these vital drugs and reduce resistance, an escalating problem that threatens the ability to effectively treat often life-threatening infections.

The guidelines note that more research is needed to determine how to ensure antibiotic stewardship is most effective. However, the best evidence to date suggests that the following components can help to ensure the implementation of an effective antibiotic stewardship program: (1) preauthorization or prospective audit and feedback; (2) syndrome-specific interventions; and (3) rapid diagnostic testing. 

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 of regimens, and using computerized clinical decision support.   —Amanda Del Signore