The Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) have released new antibiotic stewardship guidelines, which are published in the journal Clinical Infectious Diseases

The government has called for hospitals and healthcare systems to put in place antibiotic stewardship programs by 2020 to ensure appropriate use of these critical drugs and to reduce resistance. The new guidelines now focus on specific methods that evidence suggests are most beneficial to ensure the program will be effective and long-lasting. It also emphasizes that these stewardship programs tailor interventions based on local issues, resources, and expertise. Physicians and pharmacists are recommended to lead the programs in coordination with the expertise of infectious disease specialists. 

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Authors of the guidelines noted that although more studies are needed to demonstrate how antibiotic stewardship is most effective, the best current evidence suggests the following components to help implement an effective antibiotic stewardship program:

  • Preauthorization or prospective audit and feedback: Targeted antibiotics, such as those that treat emerging drug-resistant bacterial infections, should require preauthorization. Prospective audit and feedback can be an alternate strategy or combined with preauthorization.
  • 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. 
  • 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. They also note that the rapid testing of blood cultures in addition to conventional culture is helpful, but should be guided by the antibiotic stewardship team for maximum benefit to the patient.

In addition, the guidelines recommend reducing antibiotic use associated with Clostridium difficile infection, enforcing antibiotic time-outs, and other ways to encourage routine regimen reviews and using computerized clinical decision support if possible. Education materials such as lectures and brochures, should play a more supplemental role to antibiotic preauthorization and prospective audit and feedback.

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