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Review antibiotic treatment within 48 hours, DH guidance recommends

By Clinical Pharmacist

Antibiotic treatment for hospital inpatients should be reviewed within 48 hours of being started, and an ongoing management plan documented clearly in the medical notes, according to recently published Department of Health guidance.

“Start smart — then focus” is an antimicrobial stewardship guide for hospitals in England. It details a strategy to reduce healthcare-associated infection rates and slow the development of antimicrobial resistance (see Panel).

Philip Howard, consultant pharmacist for antimicrobials at Leeds Teaching Hospitals NHS Trust, told Clinical Pharmacist that the guidance was developed in consultation with the United Kingdom Clinical Pharmacy Association’s infection management group.

“The guidance contains a range of tools to help organisations deliver the recommendations and audit their antimicrobial practices,” added Mr Howard, who was a member of the guidance development group.

He suggested that the guidance should reduce broad-spectrum antibiotic prescribing and help hospitals meet their statutory obligations, with respect to infection prevention and control.

The guidance also recommends that antibiotic stewardship committees include at least two pharmacists (one managerial and one antimicrobial) and that local prescribing guidelines are updated regularly.

Start smart, then focus

The recommendations outlined in the Department of Health’s guide to antibiotic stewardship for hospitals in England can be divided into two main areas:

Start smart

  • Do not start antibiotics if there is no evidence of bacterial infection
  • If there is evidence or suspicion of bacterial infection, use local guidelines to start prompt, effective antibiotic treatment
  • Obtain cultures before starting therapy
  • Document the clinical indication, duration or review date, route of administration and dose on the drug chart and in the medical notes
  • Prescribe single-dose antibiotics for surgical prophylaxis, if antibiotics have been shown to be effective


  • Review the clinical diagnosis and the continuing need for antibiotics within 48 hours and make a clear plan of action, namely: stop; switch from IV to oral; change; continue; or use outpatient parenteral antibiotic therapy
  • Document the review and ongoing treatment plan in the medical notes

Citation: Clinical Pharmacist URI: 11090926

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