Local Guidelines and Protocols


Oliver J Dyar, Kidlington (UK) and Cèline Pulcini, Nice (France)


Developing local guidelines and protocols is a key step in implementing antimicrobial stewardship programmes in a specific hospital or community setting. Combining relevant local microbiology data with stewardship prescribing principles (e.g. empirical therapy, de-escalation, defined treatment duration) helps ensure that patients get the most appropriate treatment whilst reducing drivers of antibiotic resistance. There is growing evidence that adherence to antimicrobial guidelines at an institutional level reduces mortality and morbidity, length of hospital stay, and antibiotic costs.


Guidelines usually focus on recommending specific empirical antibiotic choices for common types of infection (pneumonia, urinary tract infection, sepsis of unknown source…), often including suggestions for individuals with penicillin allergies, or renal/hepatic failure. Adoption of local guidelines may be improved in certain circumstances by considering how antimicrobial therapy fits in with other aspects of a patient’s clinical pathway, for example through the creation of ‘sepsis care bundles’ which provide a checklist of investigations and multiple management aspects. Guidelines for outpatient antibiotic may need to emphasise the specific indications for antibiotic use, as primary care doctors tend to have less access to microbiology advice.


The antibiotic selection content of guidelines can be created through integrating national antibiotic use guidance with the local pharmacy formulary and relevant microbiology resistance data. The ADAPTE framework can be used to minimise barriers to the development and acceptance of guidelines. In particular, guidelines must be evidence-based and developed by a multidisciplinary group, involving all key stakeholders to foster acceptance and ownership.


An important step in guideline development is investigating who the main prescribers are, and targeting educational and awareness interventions towards them. Use of local guidelines can be enhanced by involving the prescribers in the development of the guidelines, making the guidelines more accessible through creating multiple formats (electronic documents, paper-based), the physical location of guidelines, and ensuring design and access consistency with other guidelines used in your setting. Local guidelines and protocols can also facilitate the auditing process of antibiotic prescribing through creating a more clearly defined gold standard, and can integrate with infection prevention and control precautions.


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References and Resources

Original articles

Review articles

Consensus documents



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