Overview of the principles of appropriate antimicrobial prescribing

This topic outlines the principles of appropriate antimicrobial use for prophylactic, empirical and directed therapy, in hospital and community practice. Appropriate antimicrobial therapy improves patient outcomes, reduces unnecessary antimicrobial use and reduces adverse consequences for the patient and the community.

Appropriate antimicrobial prescribing includes the following steps:

• decide whether antimicrobial therapy is indicated – consider if antimicrobial therapy is prophylactic, empirical or directed
• collect samples for microbiological testing, ideally, before the first dose of antimicrobial (see Interpreting microbiological testing results); do not delay antimicrobial therapy for sample collection in critically ill patients
• select an appropriate antimicrobial agent for the indication (see Selecting an appropriate antimicrobial)
• select an appropriate antimicrobial regimen, consider:
  • dose
  • frequency
  • route
  • in children, palatability and availability of an appropriate formulation
• prescribe the shortest possible duration of therapy taking into consideration the condition being treated and the patient’s clinical response (see Choosing the duration of antimicrobial therapy)
• document the prescribed antimicrobial therapy in the patient’s medical record or medication chart, including the dose, indication and the intended duration of therapy before further review or stopping therapy.