The majority of hospitalized patients receive antibiotics for therapy or prophylaxis during their inpatient stay. It has been estimated that at least fifty percent of patients receive antibiotics needlessly. Reasons include inappropriate prescribing for antibiotic prophylaxis, continuation of empiric therapy despite negative cultures in a stable patient, and a lack of awareness of susceptibility patterns of common pathogens. Overprescribing not only increases the costs of health care, but may result in superinfection due to antibiotic-resistant bacteria, as well as opportunistic fungi, and may increase the likelihood of an adverse drug reaction. On the other hand, not prescribing (when there is an urgent need at the bedside) may also lead to serious consequences.

The antimicrobial guidelines on this web site were developed by The Cleveland Clinic Infectious Disease Department, the Department of Pharmacy, and the Section of Microbiology. These materials are guidelines only and are subject to change pursuant to medical judgement relative to individual patient needs. These antimicrobial formulary decisions are made annually. In vitro susceptibility data of the previous year are shared and emerging resistance patterns reviewed. Usage and cost data are discussed. The mission of our program is to provide the most cost-effective antimicrobial agents to our patients.

This material does not include antimicrobial guidelines for transplant prophylaxis. Transplant protocols are continuously evolving with our colleagues in departments actively engaged in solid organ and bone marrow transplantation. Specific guidelines for treatment of human immunodeficiency virus (HIV) infection and prophylaxis against opportunistic micro-organisms are also not included, since such patients are primarily managed as outpatients.

Index of Guidelines