Table 4 Components of ‘Start Smart then Focus’, [36]

- Do not start antibiotics in the absence of clinical evidence of bacterial infection.

- For antibiotic(s) prescribed, document on drug chart and clinical notes: indication (including disease severity if appropriate), dose, route and duration or review date.

- Obtain cultures first where possible.

- Prescribe single dose antibiotics for surgical prophylaxis.

- Review clinical diagnosis and continuing need for antibiotics by 48–72 h and make a clear plan of action - the ‘antimicrobial prescribing decision’.

- The five ‘antimicrobial prescribing decision’ options are Stop, Switch, Change, Continue and OPAT.

- It is essential that the review and subsequent decision be clearly documented in the clinical notes. The decision should also be documented clearly on the drug chart.