Moehring et al reported criteria for de-escalation of antibiotic therapy in a hospitalized patient. The authors are from Duke University and CDC.
Patient selection: hospitalized patient being treated with antibiotics
The authors use an antibiotic-ranking schema as shown in the table below.
|
Rank
|
Description
|
Examples
|
|
1
|
narrow spectrum
|
amoxicillin, ampicillin, TMP/SMX, nafcillin, oxacillin, metronidazole, doxycycline, penicillin, nitrofurantoin
|
|
2
|
broad spectrum
|
ceftriaxone, third gen oral cephalosporins, azithromycin, clarithromycin, amoxicillin + clavulanate, ampicillin + sulbactam, clindamycin
|
|
3
|
extended spectrum
|
anti-pseudomonas penicillins, fluoro-quinolones, aminoglycosides, vancomycin, cefepime, ceftazidime, ertapenem, aztreonam
|
|
4
|
protected
|
anti-pseudomonal cephalosporins, colistin, tigecycline, linezolid, tedizolid, daptomycin, ceftaroline, ceftolozane + tazobactam, ceftazidime + avibactam
|
Dates evaluated:
(1) first calendar day of antibiotic therapy
(2) either day of discharge OR fifth calendar day of antibiotic therapy
Measurements on each date:
(1) number of antibiotics being received
(2) rank number of antibiotic (if more than 1 antibiotic being received, then the highest one)
Criteria for de-escalation - one or both of the following:
(1) decrease in number of antibiotics from Day 1 to Day 5/discharge
(2) decrease in rank number from Day 1 to Day 5/discharge
Criteria for escalation - one or both of the following:
(1) increase in number of antibiotics
(2) increase in rank number
Any other pattern is designated unchanged.
