What is “antibiotic stewardship” and why is it important?

Best practices for antibiotic stewardship are built around several fundamental principles. Often these are described as giving the right antibiotic, at the right dose, for the right duration of therapy. Indeed, prescribing the wrong antibiotic, or at the wrong dose, can lead to bad outcomes for patients with bacterial infections. Prescribing the right drug at the right dose, but for an unnecessarily long course, also leads to overuse and selects for antibiotic resistance.

However, often overlooked is a more fundamental principle that must underpin effective antibiotic stewardship: making the correct diagnosis. We present several cases that illustrate this critical principle and the impact it has on appropriate antibiotic usage. These cases are based on real patients we have encountered recently. We present them not because they are unusual but rather because they are typical of clinical situations that happen tens of thousands of times per year in the United States.

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