General principles for antibiotic prescribing

Antibiotics should only be administered if the clinical likelihood of a bacterial infection is high

1. In patients with suspected sepsis or other life-threatening infections, effective antibiotic treatment should be initiated within one hour of diagnosis (or as soon as possible). 
2. Ensure that relevant microbiological samples are taken. Diagnostic methods such as rapid tests for antibiotic resistance may be helpful.
3. Take a thorough drug allergy history to identify any allergies in patients and potential contraindications for specific antibiotics. 
4. Adhere to local guidelines for empirical antibiotic therapy, unless an exception is clearly justified (e.g. in cases of known colonisation with MDROs, etc.).
5. Document: 
   1. Clinical indication, dose and route of administration depending on severity/patient factors
   2. known MDRO colonisation
   3. date of review/discontinuation or duration of treatment

Review the treatment based on the clinical course and microbiological results, and decide:

1. STOP antibiotics?
   If there are no signs of a bacterial infection or if a bacterial infection is unlikely. 
2. Switch antibiotics? 
   De-escalation/adjustment from empirical to targeted therapy, depending, amongst other things, on the microbiological results and the clinical course.
3. Switch from intravenous to oral therapy? 
   If there is a satisfactory clinical response and if there are no infection- or patient-specific indications for continuing intravenous antibiotic therapy. 
4. Continue current treatment? 
   If so: check that the dosage is still correct. 
   Consider referring the patient to an infectious diseases specialist and/or a hospital pharmacist.
5. Outpatient Parenteral Antibiotic Therapy (OPAT)? 
   Intravenous administration of antibiotics may also be continued on an outpatient basis, provided the patient is clinically stable, a suitable agent is available and patient safety can be ensured. Enquire about regional OPAT services.

Document all decisions, including the date of the next review.

Integrate the application of the general principles into continuing professional development, awareness campaigns (displaying materials such as flyers, posters and checklists in relevant locations), clinical practice and prescription audits.