Action 4:
Review and reassess
antibiotics at 48 hours
Key points:

Review antibiotic therapy within 24-48 hours
to assess the appropriateness of therapy

Use Gram stain culture and antibiotic
susceptibility test results available at the
Reviewing and reassessing antibiotic therapy helps ensure
time of review to reassess the
that appropriate treatment is being given and that the risk of
appropriateness of therapy
poor outcomes, including treatment failure and antibiotic
related adverse events, are minimised.1

Consider the need to change, discontinue or
switch from intravenous to oral antibiotic
Culture results, including identification and antibiotic
susceptibility test results, are usually available 24-48 hours
after specimen collection. Results of some tests (such as
Gram stain or PCRsi ) may be available soon after the
therapy, at the time of review

Document the outcome of the review in the
patient’s medical record
specimen arrives in the lab, allowing more directed therapy
to be chosen soon after initial therapy is commenced. The results of these tests should be used to reassess the
appropriateness of the initial therapy prescribed, along with the patient’s clinical progress and other investigation
results.
For empiricii antibiotic therapy, a formal review at 24-48 hours can be useful for re-evaluating clinical information,
and making a plan for antibiotic treatment. The outcome of this review should be documented in the patient’s
medical record.
The US Centers for Disease Control and Prevention (CDC) refers to this type of review of therapy as an “antibiotic
time-out”.2, 3 Typical interventions might include:1, 4-5

Revising the duration of antibiotic therapy required

Changing the antibiotic to a narrower spectrum i.e. streamlining or de-escalation

Changing the antibiotic when the initial regimen was inactive

Switching from intravenous (IV) to oral therapy

Discontinuing antibiotic therapy (for example if results indicate a viral infection)

Seeking expert advice from an infectious diseases (ID) specialist or clinical microbiologist
i
PCR - Polymerase chain reaction
ii
Empiric antibiotic therapy is antibiotic therapy that is commenced before the causative organism has been identified. For example, before
culture and antibiotic susceptibility test results are available.
Results from the National Antibiotic Prescribing Survey in 2013 indicate that 23% of hospital antibiotic prescriptions
were deemed to be inappropriate. Of the 2,930 inappropriate prescriptions identified, half were either too broad or
prescribed for the incorrect duration. These results demonstrate the importance of timely review to ensure the most
appropriate therapy in order to ensure the best patient outcomes.
Useful resources
The Antimicrobial Stewardship (AMS) Clinical Care Standard.
The Antimicrobial Stewardship (AMS) Clinical Care Standard aims to ensure that a patient with a
bacterial infection receives optimal treatment with antibiotics. It provides advice to clinicians,
consumers and health services on key components of care related to antibiotic therapy. The AMS
Clinical Care Standard is due for publication late 2014. For more information, visit
www.safetyandquality.gov.au/ccs
References and further reading
1. Duguid M, Cruickshank M (editors). Antimicrobial Stewardship in Australian Hospitals. Sydney: Australian
Commission on Safety and Quality in Health Care, 2011.
2. US Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States, 2013.
Available at: http://www.cdc.gov/drugresistance/threat-report-2013/ accessed 30 October 2013.
3. http://blogs.cdc.gov/safehealthcare/2010/11/16/let%e2%80%99s-take-an-antibiotic-time-out/ accessed 7
November 2013.
4. Department of Health Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection
(ARHAI). Antimicrobial Stewardship: “Start smart - then focus” Guidance for antibiotic stewardship in hospitals
(England). 2011.
5. Greater New York Hospital Association United Hospital Fund. Antimicrobial stewardship toolkit – best practices
from the GYNA/UHF antibiotic stewardship collaborative (USA). 2011.
Date of publication: 24 October 2014
This document is intended for use by health professionals. It has been created from information contained in Antimicrobial Stewardship in
Australian Hospitals 2011 and reviewed by clinical experts. Reasonable care has been taken to ensure this information is accurate at the date of
creation. This fact sheet is intended to be used in its original version and can be downloaded from the Australian Commission on Safety and
Quality in Health Care web page www.safetyandquality.gov.au
“No action today, no cure tomorrow” is adopted from the WHO World Health Day 2011 .
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