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Int J Antimicrob Agents. 2016 Sep;48(3):239-46. doi: 10.1016/j.ijantimicag.2016.06.015. Epub 2016 Jul 25.

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.

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Hospital Carlos G. Durand, Buenos Aires, Argentina. Electronic address:
American University of Beirut Medical Centre, Beirut, Lebanon.
Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy; Antimicrobial Stewardship Programme, Annecy-Genevois Hospital Centre, Annecy, France.
University of Miami Miller School of Medicine, Miami, FL, USA.
Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
Nuffield Department of Medicine, University of Oxford, UK; Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Fundación Lusara, Mexico City, Mexico.
Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France.
Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Department of Infectious Diseases, Medical Faculty, Hacettepe University, Ankara, Turkey.
Medical Microbiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, UK.


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.


Antimicrobial resistance; Antimicrobial stewardship; Combination therapy; Prudent use of antibiotics

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