Antibiotic Stewardship Decisions

Clinical Objective

Apply evidence-based criteria to antibiotic prescribing decisions in the postoperative period, ensuring that antimicrobials are used when genuinely indicated, at the correct dose and duration, and that antimicrobial resistance implications are considered for every prescription.

Protocol Steps

1. 1

   Confirm the clinical indication for antibiotics: documented infection (culture and sensitivity), high-risk contaminated wound, or evidence-based prophylaxis criteria.

2. 2

   Obtain wound culture and sensitivity before initiating antimicrobial therapy whenever possible.

3. 3

   Select the narrowest-spectrum agent that covers the likely or confirmed organisms.

4. 4

   Define the expected treatment duration at the time of prescribing — open-ended prescriptions are stewardship failures.

5. 5

   Reassess the patient at the 48–72 hour mark: de-escalate to a narrower agent if culture results permit.

6. 6

   Discontinue antibiotics when the infection has resolved — do not complete a fixed course if clinical resolution is evident earlier.

7. 7

   Document antimicrobial use, indication, duration, and outcome in the medical record for audit purposes.

Key Pitfalls to Avoid

• Prescribing antibiotics for normal post-surgical inflammation that has not met the criteria for infection.

• Using combination broad-spectrum regimens for simple skin/soft-tissue infections without culture justification.

• Reflexively renewing antibiotic courses without reassessment when clients report 'it doesn't seem better yet.'

• Failing to obtain culture and sensitivity before beginning antibiotics, then having no microbiological data to guide adjustments.