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Documenting the indication for antimicrobial prescribing: a scoping review
  1. Sharon Saini1,
  2. Valerie Leung2,3,
  3. Elizabeth Si1,
  4. Certina Ho1,4,
  5. Anne Cheung5,
  6. Dan Dalton6,
  7. Nick Daneman2,7,8,9,
  8. Kelly Grindrod10,
  9. Rita Ha11,
  10. Warren McIsaac12,13,
  11. Anjali Oberai14,15,
  12. Kevin Schwartz2,16,
  13. Anastasia Shiamptanis17,
  14. Bradley J Langford18
  1. 1 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
  2. 2 Public Health Ontario, Toronto, Ontario, Canada
  3. 3 Michael Garron Hospital, Toronto East Health Network, Toronto, Ontario, Canada
  4. 4 Institute for Safe Medication Practices, Toronto, Ontario, Canada
  5. 5 West Park Healthcare Centre, Toronto, Ontario, Canada
  6. 6 CareRx, Ottawa, Ontario, Canada
  7. 7 Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  8. 8 ICES, Toronto, Ontario, Canada
  9. 9 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  10. 10 University of Waterloo, Waterloo, Ontario, Canada
  11. 11 North York Family Health Team, Toronto, Ontario, Canada
  12. 12 Sinai Health System, Toronto, Ontario, Canada
  13. 13 Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  14. 14 Wawa Family Health Team, Wawa, Ontario, Canada
  15. 15 Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
  16. 16 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  17. 17 New Brunswick College of Pharmacists, Moncton, New Brunswick, Canada
  18. 18 Hotel Dieu Shaver Health and Rehabilitation Centre, St. Catharines, Ontario, Canada
  1. Correspondence to Dr Bradley J Langford, Infection Prevention and Control, Public Health Ontario, Toronto, Canada; brad.langford{at}


Background Documenting an indication when prescribing antimicrobials is considered best practice; however, a better understanding of the evidence is needed to support broader implementation of this practice.

Objectives We performed a scoping review to evaluate antimicrobial indication documentation as it pertains to its implementation, prevalence, accuracy and impact on clinical and utilisation outcomes in all patient populations.

Eligibility criteria Published and unpublished literature evaluating the documentation of an indication for antimicrobial prescribing.

Sources of evidence A search was conducted in MEDLINE, Embase, CINAHL and International Pharmaceutical Abstracts in addition to a review of the grey literature.

Charting and analysis Screening and extraction was performed by two independent reviewers. Studies were categorised inductively and results were presented descriptively.

Results We identified 123 peer-reviewed articles and grey literature documents for inclusion. Most studies took place in a hospital setting (109, 89%). The median prevalence of antimicrobial indication documentation was 75% (range 4%–100%). Studies evaluating the impact of indication documentation on prescribing and patient outcomes most commonly examined appropriateness and identified a benefit to prescribing or patient outcomes in 17 of 19 studies. Qualitative studies evaluating healthcare worker perspectives (n=10) noted the common barriers and facilitators to this practice.

Conclusion There is growing interest in the importance of documenting an indication when prescribing antimicrobials. While antimicrobial indication documentation is not uniformly implemented, several studies have shown that multipronged approaches can be used to improve this practice. Emerging evidence demonstrates that antimicrobial indication documentation is associated with improved prescribing and patient outcomes both in community and hospital settings. But setting-specific and larger trials are needed to provide a more robust evidence base for this practice.

  • medication safety
  • antibiotic management
  • general practice
  • healthcare quality improvement
  • implementation science

Data availability statement

Data are available on reasonable request.

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  • Contributors SS, VL and BJL contributed to conceptualisation of the project. All authors contributed to methodology. SS, VL, ES and BJL contributed to data curation. BL performed the formal analysis. SS and BJL wrote the original draft. All authors contributed to review and editing of manuscript. BJL is the guarantor of this study.

  • Funding This scoping review was carried out as part of the authors’ routine work.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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