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Antimicrobial Stewardship — SCE Infectious Diseases MCQ

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EasyAntimicrobial StewardshipAntimicrobial StewardshipSCE Infectious Diseases

An antibiotic stewardship pharmacist reviews the prescribing of a patient receiving IV Meropenem for hospital-acquired pneumonia. The patient has been afebrile for 72 hours, inflammatory markers are downtrending, and sputum culture grew a fully sensitive Escherichia coli. What is the most appropriate antibiotic stewardship intervention?

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Correct answer: D — IV-to-oral switch to a narrower-spectrum agent such as Co-amoxiclav

This represents a classic antibiotic stewardship opportunity: the patient is clinically improving and the organism is fully sensitive. The principles of stewardship include de-escalation to the narrowest effective agent and IV-to-oral switch when clinically appropriate (usually after 48–72 hours of clinical improvement). Co-amoxiclav oral is appropriate for a fully sensitive E. coli causing pneumonia in a clinically improving patient. Continuing broad-spectrum IV therapy drives resistance and increases C. difficile risk.

Reference: NICE NG15 2015 (updated 2024) – Antimicrobial stewardship; BSAC 2023 – Stewardship toolkit