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January 15, 2019

Rethinking How Antibiotics Are Prescribed: Incorporating the 4 Moments of Antibiotic Decision Making Into Clinical Practice

Author Affiliations
  • 1Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
  • 2Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, Maryland
  • 3Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
JAMA. 2019;321(2):139-140. doi:10.1001/jama.2018.19509

Antibiotics save countless lives, but can also cause significant harm including antibiotic-associated adverse events, Clostridium difficile (also known as Clostridioides difficile) infections, increasing antibiotic resistance, and changes to the microbiome (the implications of changes to the microbiome are only beginning to be understood).1 Antibiotic stewardship programs have become increasingly commonplace in hospitals in the United States and around the world, but these programs almost always rely heavily on restrictive practices (eg, requiring approval before prescribing certain antibiotics) or persuasive practices (eg, discussions with clinicians regarding the continued need for antibiotics).2 Although these approaches have had success in improving antibiotic use,2 they depend on external motivators, and their ability to influence how clinicians will prescribe antibiotics in the absence of an antibiotic stewardship program–driven intervention is questionable.

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