Indications for medical antibiotic prophylaxis and potential targets for antimicrobial stewardship intervention: a narrative review

Background Most of the antimicrobial stewardship (AMS) literature has focused on antimicrobial consumption for the treatment of infections, for surgical site infection prophylaxis and for prevention of endocarditis. The role of AMS for medical antibiotic prophylaxis (AP) has not been adequately addressed. Objectives To identify targets for AMS interventions for medical AP in adult patients. Sources Narrative review. Content The various indications for medical AP and relevant evidence from practice guidelines are outlined. The following were identified as potential targets for AMS interventions: (1) addressing underutilization of antibiotic-sparing strategies (e.g. for recurrent urinary tract infections, recurrent soft-tissue infections, recurrent exacerbations associated with bronchiectasis or chronic obstructive pulmonary disease), (2) reducing unnecessary AP beyond recommended indications (e.g. for acute pancreatitis, bite wounds, or urinary catheter manipulations), (3) reducing use of broader-spectrum than necessary AP, (4) reducing use of AP for longer than recommended (e.g. AP for prevention of osteomyelitis in open fractures or AP in high-risk neutropenia), (5) evaluating the role of antibiotic cycling to prevent emergence of resistance during prolonged AP (e.g. in recurrent urinary tract infections or prophylaxis for spontaneous bacterial peritonitis), (6) addressing research gaps regarding appropriate indications or antibiotic regimens for medical prophylaxis. Implications This review summarizes current trends in AP and proposes targets for AMS interventions.