Antibiotic Stewardship

The discovery of antibiotics was one of the most important medical advances of the 20th century. Their use continues to be critically important in the care of both children and adults with serious infections. However, increasing antibiotic use has also led to the development of antibiotic resistance and a rise in harms related to antibiotics, including antibiotic-associated adverse events and Clostridioides difficile infections. There is growing recognition of the broader impact of antibiotic overuse in children, including associations with obesity, asthma, and environmental allergies. Studies have demonstrated that antibiotic use is highly variable and that at least half of antibiotic prescriptions are unnecessary, highlighting that there is room for improvement.

The overarching goal of antibiotic stewardship programs (ASPs) is to collaborate with clinicians to optimize the use of antibiotics to effectively treat infections while minimizing patient harm. ASPs are most successful when they are led jointly by a physician and a pharmacist, particularly when both have infectious diseases training. There are 2 primary approaches that ASPs use in hospitals to facilitate appropriate antibiotic use among frontline clinicians: preauthorization and postprescription review. In preauthorization, clinicians request approval from the ASP before prescribing certain antibiotics. This approach enables the ASP to provide guidance early, which may improve empirical therapy for serious conditions such as sepsis and reduce unnecessary antibiotic use before it is initiated. It also enables the stewardship team to provide guidance on optimal diagnostic testing. In postprescription review, the stewardship team advises the primary team after antibiotics have been started, once additional clinical and diagnostic data …