Abstract Background Antimicrobials are essential for treating and preventing bacterial infections, yet inappropriate use drives the development of antimicrobial resistance (AMR), posing a major global health challenge. Antimicrobial stewardship (AMS) aims to optimise antibiotic use, making the definition and measurement of “appropriate” prescribing critical. Objectives The primary objective was to identify indicators used to measure appropriateness of antibiotic prescribing in high-income countries. The secondary objective was to describe levels of inappropriate prescribing in high-income countries. Methods A rapid systematic review (registration no: CRD42024628584) was conducted using Embase, Medline and Cochrane databases. Eligible studies reported indicators for measuring appropriateness of antibiotic prescribing in high-income countries. Each article was independently reviewed for inclusion, extracted, and assessed for risk of bias by one reviewer, with dual screening of 10%. Indicators were grouped as general or proxy indicators, further synthesised thematically, and described narratively. Quantitative data on inappropriateness for general indicators were standardised and summarised. Results This rapid review identified 103 unique indicators from 165 studies: 58 general indicators from 128 studies and 45 proxy indicators from 38 studies. The most frequent general indicator was compliance with guidelines (90/128, 70%). The most common proxy indicator was rate of prescribing by indication (22/38, 58%). Indicators were applied across diverse settings, populations, and types of infection. Among studies describing general indicators, 103/128 gave quantifiable outcomes for inappropriateness of prescribing, ranging from 2% to 88%. Conclusions The review highlights the wide variety of indicators used to assess appropriateness of antibiotic use in high-income countries, reflecting the complexity of the concept. Most indicators focused on whether the correct antibiotic, dose, frequency, and duration was prescribed, in-line with clinical guidance and tailored to the clinical context - core principles of AMS. These findings provide a valuable resource for those aiming to monitor and improve antibiotic prescribing practices. 

pdf/measuring-appropriateness-of-antibiotic-prescribing-in-high-fkh1rsz7b07p.pdf

Measuring appropriateness of antibiotic prescribing in high-income countries: a rapid systematic review of indicators

Identifying opportunities to safely reduce antibiotic prescribing is necessary for prescribers and antibiotic stewardship teams to minimise unwarranted antibiotic use. We aimed to quantify excess antibiotic use in General Surgery. We retrospectively audited the antibiotic prescribing for patients discharged from the General Surgery specialty in an acute hospital in the south-west of England for one month using an audit tool developed by Public Health England. The appropriateness of prescribing was determined for each patient at three antibiotic decision time-points: at initiation, the pre-72-h antibiotic review, and treatment duration. Two infection specialists and a general surgeon reviewed each patient. Indication and excess days of therapy (DOTs) were calculated at each decision time-point and expressed as a proportion of total DOTs. Eighty-six patients were prescribed 1162 DOTs; 192 (16.5%) excess DOTs were prescribed in 38 patients (44%), with zero excess days identified in the remaining 48 patients (56%). Seventy-five of 192 (39%) excess DOTs occurred at initiation; 55/192 (29%) after the pre-72-h antibiotic review; and 62/192 (32%) due to protracted antibiotic courses. There was concordance between the general surgeon and infection specialist for most apportioned excess DOTs. However, the surgeon apportioned fewer excess DOTs 160/1162 (13.8%). Overall IV antibiotics accounted for 53.4% of total DOTs. Seventy-two of 86 (83.7%) patients received 620 intravenous DOTs; of these, 79 (12.7%) IV DOTS were unnecessary. We have identified excess antibiotic prescribing in General surgery with comparable excess DOTs at all three time-points.

/pdf/identification-of-intervention-opportunities-through-q9yvo2je.pdf

Identification of Intervention Opportunities through Assessment of the Appropriateness of Antibiotic Prescribing in Surgical Patients in a UK Hospital Using a National Audit Tool: A Single Centre Retrospective Audit

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Identification of Intervention Opportunities through Assessment of the Appropriateness of Antibiotic Prescribing in Surgical Patients in a UK Hospital Using a National Audit Tool: A Single Centre Retrospective Audit