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Clin Infect Dis. 2014 Oct 15;59 Suppl 3:S154-61. doi: 10.1093/cid/ciu548.

Assessing appropriateness of antimicrobial therapy: in the eye of the interpreter.

Author information

Global Medical Affairs, Cubist Pharmaceuticals, Lexington, Massachusetts.
Department of Pharmacy, Huntsville Hospital, Alabama.
Department of Pharmacy, University of Arkansas for Medical Sciences Medical Center, Little Rock.
Creighton University School of Pharmacy and Health Professions, Omaha, Nebraska.
College of Pharmacy, University of New Mexico, Albuquerque.
Global Medical Affairs, Cubist Pharmaceuticals, Lexington, Massachusetts Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Worcester/Manchester.
Global Medical Affairs, Cubist Pharmaceuticals, Lexington, Massachusetts Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha.


To address the increase of drug-resistant bacteria and widespread inappropriate use of antimicrobials, many healthcare institutions have implemented antimicrobial stewardship programs to promote appropriate use of antimicrobials and optimize patient outcomes. However, a consensus definition of appropriate use is lacking. We conducted a multicenter observational study to compare 4 definitions of appropriateness--a study site-specific definition, use supported by susceptibility data, use supported by electronic drug information resources (Clinical Pharmacology/Micromedex), or study site principal investigator (PI) opinion-among patients receiving 1 or more of 13 identified antimicrobials. Data were collected for 262 patients. Overall, appropriateness with the 4 definitions ranged from 79% based on PI opinion to 94% based on susceptibility data. No single definition resulted in consistently high appropriate use for all target antimicrobials. For individual antimicrobials, the definitions with the highest rate of appropriate use were Clinical Pharmacology/Micromedex support (6 of 7 antimicrobials) and susceptibility data (5 of 7 antimicrobials). For specific indications, support from susceptibility data resulted in the highest rate of appropriate use (4 of 7 indications). Overall comparisons showed that appropriateness assessed by PI opinion differed significantly compared with other definitions when stratified by either target antimicrobial or indication. The significant variability in the rate of appropriate use highlights the difficulty in developing a standardized definition that can be used to benchmark judicious antimicrobial use.


antimicrobial prescribing behavior; antimicrobial stewardship program; antimicrobial therapy; observational study

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