Antimicrobial choice and treatment plan in ambulatory antimicrobial therapy

The principles of appropriate antimicrobial prescribing and Antimicrobial stewardship (AMS) apply in ambulatory antimicrobial therapy programs. Key principles include:

• choosing the antimicrobial regimen according to prescribing guidelines
• avoiding using parenteral antimicrobial therapy when oral therapy is available and appropriate. Some antimicrobials have good oral bioavailability and can often be given orally rather than intravenously (see Examples of antimicrobials with good oral bioavailability)
• not using parenteral antimicrobial therapy for longer than necessary – switch to oral therapy as soon as it is clinically appropriate to do so (see Guidance for antimicrobial intravenous to oral switch)
• documenting the infection treatment plan in the patient’s records before admission to an ambulatory antimicrobial therapy service, including the expected duration of therapy and the plan for follow-up after completing therapy. If prolonged ambulatory antimicrobial therapy is required, seek expert advice from an infectious diseases physician. Input from an infectious diseases physician has been shown to decrease inappropriate antimicrobial prescribing; improve selection of antimicrobial agents and improve early intravenous to oral switching of the antimicrobial agent.