title: Ten key points for the appropriate use of antibiotics in hospitalised patients: a consensus from the Antimicrobial Stewardship and Resistance Working Groups of the International Society of Chemotherapy.
abstract: The Antibiotic Stewardship and Resistance Working Groups of the International Society for Chemotherapy propose ten key points for the appropriate use of antibiotics in hospital settings. (i) Get appropriate microbiological samples before antibiotic administration and carefully interpret the results: in the absence of clinical signs of infection, colonisation rarely requires antimicrobial treatment. (ii) Avoid the use of antibiotics to 'treat' fever: use them to treat infections, and investigate the root cause of fever prior to starting treatment. (iii) Start empirical antibiotic treatment after taking cultures, tailoring it to the site of infection, risk factors for multidrug-resistant bacteria, and the local microbiology and susceptibility patterns. (iv) Prescribe drugs at their optimal dosing and for an appropriate duration, adapted to each clinical situation and patient characteristics. (v) Use antibiotic combinations only where the current evidence suggests some benefit. (vi) When possible, avoid antibiotics with a higher likelihood of promoting drug resistance or hospital-acquired infections, or use them only as a last resort. (vii) Drain the infected foci quickly and remove all potentially or proven infected devices: control the infection source. (viii) Always try to de-escalate/streamline antibiotic treatment according to the clinical situation and the microbiological results. (ix) Stop unnecessarily prescribed antibiotics once the absence of infection is likely. And (x) Do not work alone: set up local teams with an infectious diseases specialist, clinical microbiologist, hospital pharmacist, infection control practitioner or hospital epidemiologist, and comply with hospital antibiotic policies and guidelines.
authors: Hospital Carlos G. Durand, Buenos Aires, Argentina. Electronic address: glevyhara@fibertel.com.ar.
authors: Gabriel
authors: G
authors: Levy Hara
authors: American University of Beirut Medical Centre, Beirut, Lebanon.
authors: Souha S
authors: SS
authors: Kanj
authors: Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy; Antimicrobial Stewardship Programme, Annecy-Genevois Hospital Centre, Annecy, France.
authors: Leonardo
authors: L
authors: Pagani
authors: University of Miami Miller School of Medicine, Miami, FL, USA.
authors: Lilian
authors: L
authors: Abbo
authors: Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
authors: Andrea
authors: A
authors: Endimiani
authors: Nuffield Department of Medicine, University of Oxford, UK; Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors: Heiman F L
authors: HF
authors: Wertheim
authors: Fundación Lusara, Mexico City, Mexico.
authors: Carlos
authors: C
authors: Amábile-Cuevas
authors: Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France.
authors: Pierre
authors: P
authors: Tattevin
authors: Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors: Shaheen
authors: S
authors: Mehtar
authors: Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors: Fernando
authors: F
authors: Lopes Cardoso
authors: Department of Infectious Diseases, Medical Faculty, Hacettepe University, Ankara, Turkey.
authors: Serhat
authors: S
authors: Unal
authors: Medical Microbiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, UK.
authors: Ian
authors: I
authors: Gould
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000188:drug therapy*; D004358:Drug Therapy / Q000379:methods* / Q000592:standards; D004363:Drug Utilization / Q000592:standards*; D006761:Hospitals; D006801:Humans; D007297:Inpatients; D012958:Societies, Scientific
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial resistance; Antimicrobial stewardship; Combination therapy; Prudent use of antibiotics