The Centers for Disease Control and Prevention (CDC) has outline the requirements for antibiotic stewardship in a hospital. They have developed a checklist to ensure conformity with these requirements.

Sections (total 39 items):

(1) leadership support (2 items)

(2) accountability (1 item)

(3) drug expertise and clinical support (7 items)

(4) actions to support optimal antibiotic use - policies (2 items)

(5) actions to support optimal antibiotic use - broad interventions (3 items)

(6) actions to support optimal antibiotic use - pharmacy-driven interventions (5) items

(7) actions to support optimal antibiotic use - interventions specific for diagnosis/infection (7 items)

(8) tracking - process measures (3 items)

(9) tracking - antibiotic use and outcome measures (2 items)

(10) tracking - monitor of antibiotic use (3 items)

(11) reporting to staff about improving antibiotic use and resistance (3 items)

(12) education (1 item)


(1A) formal, written statement of support from hospital leadership

(1B) hospital budget item supporting antibiotic stewardship

(2A) physician leader responsible for program outcome

(3A) pharmacist leader working to improve antibiotic use

(3B) clinician support

(3C) infection control and prevention support

(3D) quality improvement support

(3E) laboratory support

(3F) information technology support

(3G) nursing support

(4A) policy to document antibiotic orders with name, dose, duration and indication for each antibiotic

(4B) facility-specific treatment recommendations based on national guidelines and local susceptibility

(5A) formal procedure for clinicians to review all antibiotic orders at 48 hours

(5B) need for certain specified antibiotic agents to be approved prior to use

(5C) audit of use of these specified antibiotics

(6A) automatic change of antibiotic from IV to oral route when appropriate

(6B) adjustments of dose for organ dysfunction

(6C) dose optimization for organisms with reduced susceptibility

(6D) automatic alerts for duplicate orders

(6E) time-sensitive automatic stop orders for specified antibiotic orders

(7A) specific recommendations for community-acquired pneumonia (CAP)

(7B) specific recommendations for urinary tract infection

(7C) specific recommendations for skin and soft tissue infections

(7D) specific recommendations for surgical prophylaxis

(7E) specific recommendations for empirical treatment of MRSA

(7F) specific recommendations for new cases of C. difficile infection (CDI)

(7G) specific recommendations for culture-proven, invasive infections (sepsis, etc)

(8A) monitor adherence to documentation requirements

(8B) monitor adherence to facility-specific treatment recommendations

(8C) monitor compliance with one or more of the specific interventions

(9A) track rates of Clostridium difficile

(9B) track antibiotic susceptibility patterns with facility-specific antibiogram

(10A) track antibiotic use by day of therapy

(10B) track the number of grams of antibiotics administered

(10C) track costs and expenditures

(11A) share findings with prescribers

(11B) share antibiogram with prescribers

(11C) provide precise, personalized communications on how to improve antibiotic prescribing

(12A) provide education on how to improve use of antibiotics


Each item is answered Yes or No.


Supportive documentation is helpful.

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