‘I-OCD’: A bedside protocol for antibiotic stewardship in hospitalised patients

Abstract

Antimicrobial resistance is a growing public health threat. In hospital settings, antimicrobial decisions must be both prompt and precise. We propose the ‘I-OCD’ approach, a simple bedside mnemonic to guide daily antibiotic decision-making for hospitalised patients with fever. ‘I-OCD’ encourages clinicians to: assess evidence of Infection and determine if antimicrobials are required based on its Origin and likely Organisms, obtain appropriate Cultures before initiation, and conduct Daily review of Dose, Duration, and De-escalation. Empiric therapy should be guided by likely organisms, local antibiograms, and illness severity, rather than defaulting to broad-spectrum coverage. Beyond clinical guidelines, it promotes a behavioural mindset akin to persons with Obsessive-Compulsive Disorder: clinicians as meticulous ‘washers and checkers’, committed to hand hygiene and reassessment of antimicrobial need and invasive devices.