Clinical Report: Defining Appropriate Antibiotics

Overview

A scoping review reveals inconsistencies in defining appropriate antibiotic therapy (AAT) in clinical research, often focusing solely on in vitro susceptibility. The findings suggest that these definitions may not align with modern antimicrobial stewardship priorities, impacting patient outcomes.

Background

Appropriate antibiotic therapy is critical for improving outcomes in hospitalized patients with bacterial infections. However, the variability in definitions of AAT can lead to confusion and hinder effective antimicrobial stewardship. Understanding how AAT is defined and its implications on patient care is essential for optimizing treatment strategies.

Data Highlights

Key Findings

• 98.6% of studies provided a definition of AAT, but these varied widely.
• 41% of definitions for empiric therapy relied solely on in vitro susceptibility testing.
• Definite appropriate therapy was associated with improved outcomes in 81% of analyses.
• Incorporating minimum treatment duration in definitions was linked to reduced mortality.
• Fewer than 5% of definitions included guideline adherence, crucial for antimicrobial stewardship.

Clinical Implications

Clinicians should be aware of the variability in definitions of appropriate antibiotic therapy and consider incorporating multidimensional criteria that include dosing, duration, and guideline adherence. Standardizing definitions can enhance comparability across studies and improve patient outcomes.

Conclusion

The review underscores the need for standardized, multidimensional definitions of appropriate antibiotic therapy to better align with antimicrobial stewardship goals and improve patient care outcomes.

References

1. Infection, 2026 -- Assessing appropriateness of antibiotic therapy: a scoping review of definitions and their clinical implication
2. Infection, 2024 -- Antibiotic Treatment Not Recommended for Asymptomatic Bacteriuria
3. Infection, 2020 -- The Concept of Selective Toxicity in Antibacterial Agents: Are We Overlooking Opportunities and Underestimating Risks?
4. Infection — Innovative Antibacterial Approaches Preserving the Microbiome: A Comprehensive Review of Lolamicin
5. Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections
6. Stratifying Antibiotic Timing According to the Surviving Sepsis Campaign Seems Reasonable
7. Infection https://doi.org/10.1007/s15010-026-0273