Resisting resistance: Practical decision tools for choosing antimicrobials safely


Norma Stephens Hannigan, DNP, MPH, FNP-BC, DCC, School of Nursing, Columbia University, 617 West 168th Street, New York, NY 10032. Tel: 212-305-0059; Fax: 206-350-4422; E-mail:


Purpose: The purpose of this article is to provide, in a concise format, information about evidence-based decision-making strategies and support tools available for appropriate antimicrobial prescribing. A brief review of the current status of antimicrobial resistance, prescribing practices of nurse practitioners (NPs), and factors associated with inappropriate prescribing practices is included to further explicate the need for such support tools.

Data sources: Journal articles, Internet websites, reference texts.

Conclusions: Many microorganisms have developed resistance to previously standard treatments, and resistant strains continue to emerge. One factor associated with increasing resistance is inappropriate or overprescribing of antimicrobials sometimes related to lack of easy accessibility to clinical decision-making tools. Some practical evidence-based tools and decision-making strategies are presented here to foster making optimal antimicrobial choices in clinical practice.

Implications for practice: Evidence-based decision-making strategies and tools can be used at the point of care to maximize appropriate antimicrobial prescribing by NPs.