Action 3:
Key points:
Document indication
and review date
Documenting the indication for therapy is an important

than necessary increases the risk of
antimicrobial resistance

shared understanding of the patient’s clinical condition
of antimicrobial use

Utilise the expertise of pharmacists where
possible to ensure optimal treatment
and rationale for therapy.
Documenting indication for therapy can aid in optimising
the dose of antimicrobial
Document the indication and review date for
therapy to ensure timely review and optimisation
aspect of prescribing any medicine. It enhances the
communication between team members and ensures a
Continuing courses of antimicrobials for longer
therapy.1, 2

Pharmacists can
play an important role in optimising dosing for the
Engage senior clinicians to lead and support a
prescribing culture that includes documentation
of indication and review date for therapy
clinical condition by checking dose against guidelines
such as Therapeutic Guidelines: Antibiotic,3 to ensure the prescribed dose is appropriate to the patients individual
characteristics (e.g. renal function, weight) and clinical condition.
Ensuring the correct duration of antimicrobial therapy is important to help minimise the risk of antimicrobial
resistance. Courses of antimicrobials are often continued for longer than necessary. This may occur because
prescriptions are not time limited, and because there is no definite responsibility for a course of therapy to be
cancelled, no-one remembers to cancel them. Resistance selection increases with longer courses of antimicrobials,
as does the risk of other unwanted effects including increased length of hospital stay.
Documenting the indication and review date at the commencement of therapy can also help ensure timely review of
the patient’s progress, response to therapy and the decision to de-escalate, change therapy, cease or switch from
intravenous to oral therapy. For antimicrobial prescribing, studies have shown that documenting indication and
review date of therapy on hospital medication charts decreases unnecessary antibiotic use and reduces the
incidence of Clostridium difficile (C.difficile).7 Fact Sheet Action 4: Review and reassess antibiotics at 48 hours
provides further information regarding the importance of regularly reviewing antimicrobial therapy.
Useful resources
Refer to Therapeutic Guidelines: Antibiotic,7 for guidance on the duration of prophylactic, empirical and targeted
antimicrobial therapy.
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.
Dellit T, Owens R, McGowan J, Gerding D, Weinstein R, Burke J, Huskins W, Paterson D, Fishman N,
Carpenter C, Brennan P, Billeter M, Hooten T. Infectious Diseases Society of America (ISDA) and the
Society for Healthcare Epidemiology of America (SHEA) guidelines for developing an institutional program to
enhance antimicrobial stewardship. Clinical Infectious Diseases 2007;44(2):159-177
3.
Antibiotic Expert Group. Therapeutic Guidelines: Antibiotic. Version 14. Melbourne: Therapeutic Guidelines
Ltd; 2010
4.
National Health Service. Antimicrobial prescribing: a summary of best practice. Saving Lives: Reducing
Infection, Delivering Clean and Safe Health Care. London: UK Department of Health, 2009.
5.
Richard P, Delangle M, Merrien D, Renaud A, Minozzi C, Richet H. Fluoroquinolone use and fluoroquinolone
resistance: is there an association? Clinical Infectious Diseass 1994:19(1):54-59
6.
Guillemot D, Carbon C, Balkau B, Geslin P, Lecoeur H, Vauzelle-Dervroedan F, Bouvenot G, Eschwege E.
Low dosage and long duration of beta-lactam: risk factors for carriage of penicillin-resistant Streptococcus
pneumoniae. Journal of the American Medical Association 1998:279(5);365-370
7.
Botros S, Nathwani D. 2012. How to decrease the risk of Clostridium difficile in a ward environment and help
prevent the emergence of any new cases – a Ninewells success story. Poster presented at the International
Society for Quality in Health care 29th International Conference, Geneva 21-24 October 2012.
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 it original version. It can be downloaded from the Australian Commission on Safety and
Quality in Health Care web page www.safetyandquality/AAW2013
“No action today, no cure tomorrow” is adopted from the WHO World Health Day 2011.
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