Antibiotic Prescribing in Daily Practice: Evidence-Based Approach
Antibiotics should be prescribed using a narrow-spectrum agent whenever possible, with selection guided by local resistance patterns, specific infection diagnosis, and patient risk factors for antimicrobial resistance. 1, 2
Core Principles of Antibiotic Prescribing
Appropriate Selection
- Start with narrow-spectrum antibiotics for most common infections
- Reserve broad-spectrum antibiotics for severe infections or when narrow-spectrum options are likely to fail
- Follow the WHO AWaRe classification system (Access, Watch, Reserve) to guide selection 1
- Use local antibiograms to inform empiric therapy choices 2
Diagnostic Precision
- Obtain appropriate cultures before starting antibiotics when possible (without delaying treatment in critically ill patients)
- Document infection parameters (temperature, respiratory rate, pulse, blood pressure, WBC count, C-reactive protein) to enable treatment assessment 1
- Use clinical diagnostic criteria rather than broad-spectrum antibiotics as a substitute for accurate diagnosis 1
Stewardship Practices
- Label conditions appropriately (e.g., use "chest cold" instead of "bronchitis" for viral respiratory infections) 1
- Implement delayed prescribing strategies for conditions where benefit of antibiotics is uncertain 1
- Streamline therapy as soon as culture results become available 1
- Regularly audit antibiotic prescribing patterns 1
Infection-Specific Recommendations
Respiratory Tract Infections
- Acute Sinusitis: Amoxicillin with/without clavulanate for 5-10 days as first-line therapy 1
- Community-Acquired Pneumonia:
- Acute Bronchitis: Generally viral - avoid antibiotics unless clear evidence of bacterial infection 1
Gastrointestinal Infections
- Bacterial Diarrhea/Traveler's Diarrhea:
Urinary Tract Infections
- Uncomplicated UTI: Co-trimoxazole (10 mg/kg trimethoprim plus 40 mg/kg sulfamethoxazole twice daily for 5 days) 1
- Complicated UTI: Consider local resistance patterns; may require broader coverage initially 2
Skin and Soft Tissue Infections
- Simple Cellulitis: Cloxacillin/flucloxacillin as first-line therapy 1
- Animal/Human Bites: Amoxicillin-clavulanate (875/125 mg twice daily) 2
Special Populations
Pediatric Patients
- Adjust dosing by weight and age
- Avoid tetracyclines in children under 8 years 2
- Avoid fluoroquinolones in children under 18 years when possible 2
- For specific dosing:
Pregnant Women
- Avoid tetracyclines and fluoroquinolones 2
- Prefer penicillins, cephalosporins, and macrolides when appropriate 2
Duration of Therapy
- Respiratory infections: 5-7 days 2
- Skin and soft tissue infections: 7-10 days 2
- Urinary tract infections: 3-7 days depending on gender and complication status 2
- Use shortest effective duration to minimize resistance development 1
Common Pitfalls to Avoid
Prescribing antibiotics for viral infections: Antibiotics are often prescribed for viral conditions like acute bronchitis and common colds. This practice contributes to antibiotic resistance without benefiting patients 1.
Using broad-spectrum agents unnecessarily: Studies show that broad-spectrum antibiotics are prescribed in 54% of cases when narrow-spectrum options would be effective 5. Choose the narrowest effective agent.
Failing to adjust therapy based on culture results: Always streamline therapy when culture results become available to reduce unnecessary broad-spectrum exposure 1.
Ignoring local resistance patterns: Local antibiograms should guide empiric therapy choices as resistance patterns vary significantly between institutions 2.
Inappropriate duration: Continuing antibiotics longer than necessary increases resistance risk without improving outcomes 2.
By following these evidence-based principles, clinicians can optimize antibiotic prescribing to improve patient outcomes while minimizing the development of antimicrobial resistance.