Four Moments of Antibiotic Decision Making
The Four Moments of Antibiotic Decision Making are critical questions clinicians should be considering when deciding whether to prescribe an antibiotic.
Four Moments Questions
Before prescribing antibiotics, ensure that the patient has signs and symptoms suggesting a bacterial infection. Many patients have symptoms that are not consistent with an infection or are consistent with a viral infection; antibiotics should not be prescribed in these cases.
Consider if any diagnostic tests are needed that may help determine if the patient has a bacterial infection or what the best antibiotic might be.
Prescribe an antibiotic with the narrowest spectrum of activity needed to treat the most likely bacteria present that has the fewest side effects. Always use the shortest effective antibiotic duration for the infectious process you are treating.
Before the patient leaves the office, or prior to the end of a phone call or electronic exchange, ensure that the patient knows when they may need to contact the office, with concerns related to either the infection or the antibiotic, and when they need to schedule a followup appointment.
Implementation of the Four Moments
Several actions can be taken to integrate the Four Moments into regular practice. Local guidelines should be developed using the Four Moments framework. All “Best Practices” presentations in the Toolkit for Improving Antibiotic Use in Ambulatory Care incorporate the Four Moments framework, and most have Clinician One-Page Document templates to assist with guideline development.
The posters listed below can be reproduced for posting in common areas and workstations. These can also be shared with clinicians as well as patients and family members.
The Four Moments of Antibiotic Decision Making Poster (option 1) (PDF, 960 KB)
The Four Moments of Antibiotic Decision Making Poster (option 2) (PDF, 704 KB)