The guidance ratio: a measure of post-diagnostic antibiotic decision-making.

Authors

Kalle Garpvall, Alex Aljundi, Anna Dahl, Ellinor Sterky, Joachim Luthander, Susanne Sütterlin

Published in

JAC-antimicrobial resistance. Volume 8. Issue 4. Pages dlag195. Epub Sep 01, 2026.

Abstract

Scalable measures that capture post-diagnostic antibiotic decisions are lacking. We developed and validated the guidance ratio (GR), a registry-based measure of post-diagnostic antibiotic decision-making.
We conducted a retrospective multi-centre validation study of the GR and discontinuation ratio (DR), two registry-based indicators of post-diagnostic antibiotic decision-making in paediatric febrile urinary tract infection. Prescribing outcomes were classified using rule-based algorithms and compared with manually classified outcomes from medical record review. Indicator performance was evaluated against medical record data used as the reference standard.
Among 909 episodes, the GR identified guided treatment with a sensitivity of 0.78 and specificity of 1.00. Although registry-based estimates underestimated absolute values, they closely tracked temporal prescribing patterns. Calibration substantially improved agreement with manually classified outcomes.
The GR captured clinically meaningful prescribing patterns and may support scalable monitoring of post-diagnostic antibiotic decision-making in stewardship programmes.

PMID:
42682393
Bibliographic data and abstract were imported from PubMed on 02 Sep 2026.

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