Antimicrobial Stewardship: Prescribing restrictions

Prescription restrictions and selective resistance reporting support the appropriate prescribing of antibiotics from the ‘Watch’ and ‘Reserve’ groups.

Ensure that Watch and Reserve group antibiotics are prescribed with caution throughout the hospital

It is recommended that a list be drawn up of antibiotics in the Watch and Reserve groups for which an infectious disease consultation is mandatory when prescribing. Alternatively, the prescription of listed antibiotics can be restricted to infectious disease specialists (‘pre-authorisation’).

Ensure that resistance data is reported selectively

Selective resistance reporting is recommended for the antibiogram sent by the microbiology laboratory to prescribers. This means that certain antibiotics to which the isolated pathogens are susceptible are not displayed in the antibiogram report. The aim is to avoid an excessively broad spectrum of treatment and the development of resistance.

Examples of the use of selective reporting include ‘suppressing’ carbapenems (provided there is no resistance) and other broad-spectrum antibiotics in urine culture results, provided that sufficient sensitive alternative antibiotics are available, or ‘suppressing’ quinolones if S. aureus is sensitive to them.