Society for Healthcare Epidemiology of America

View all recommendations from this society

Released October 1, 2015; Revised December 2, 2019

Don’t continue antibiotics beyond 72 hours in hospitalized patients unless patient has clear evidence of infection.

Antibiotics are often started when an infection is suspected but not yet confirmed. After three days, laboratory and radiology information is available and antibiotics should either be deescalated to a narrow-spectrum antibiotic based on culture results or discontinued if evidence of infection is no longer present. Lessening antibiotic use decreases the risk of infections with C. difficile or antibiotic-resistant bacteria.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

A list of approximately 40 potential Choosing Wisely recommendations were collected from members of the SHEA Guidelines, Public Policy and Government Affairs, Antibiotic Stewardship, Education and Publications Committees. From those suggestions, a subgroup of the Guidelines Committee reviewed the list for duplicates and anonymously electronically ranked them. The top fifteen were sent to the SHEA Research Network for a separate ranking. Those that ranked in the top eight were reviewed by the Guidelines Committee for their appropriateness for the Choosing Wisely campaign, and five final recommendations were formally approved via individual member vote by the SHEA Guidelines Committee and the SHEA Board of Trustees.

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Core Elements of hospital antibiotic stewardship programs from the Centers for Disease Control and Prevention [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; 2015 [updated 2015 May 7; cited 2015 Jul 21]. Available from:

Antibiotic resistance threats in the United States, 2013 [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; 2013 [cited 2015 Jul 21]. Available from:

Elligsen M, Walker SA, Pinto R, Simor A, Mubareka S, Rachlis A, Allen V, Daneman N. Audit and feedback to reduce broad-spectrum antibiotic use among intensive care unit patients: a controlled interrupted time series analysis. Infect Control Hosp Epidemiol. 2012 Apr;33(4): 354-61.