This systematic review found that the use of empirical therapy according to guidelines, de-escalation of therapy, switching from intravenous to oral treatment, therapeutic drug monitoring, use of a list of restricted antibiotics, and bedside consultation, are the most important objectives of the antimicrobial stewardship programme. The overall evidence for these objectives shows benefits for clinical outcomes, adverse events, costs, resistance rates, or combinations of these. However, the included studies were generally of low quality.
A commentary notes that on the basis of these findings, there is clearly a need for more randomised multihospital trials to test the effectiveness of interventions on achieving stewardship outcomes and the subsequent effects on meaningful clinical outcomes. Specifically, robust demonstration of direct clinical benefits to individual patients would counteract the view of some health-care providers that stewardship interventions are designed for overall societal benefit. It adds that while the data on which their findings are based are far from ideal, interventions that encourage adherence to guidelines and de-escalation of therapy, as appropriate, are likely to be good starting points for any healthcare system starting an antimicrobial stewardship programme.