Clinical decision support system to guide antimicrobial selection: a narrative review from 2019 to 2023

Clinical decision support systems (CDSSs) are increasingly developed to improve healthcare delivery. To update the last review on this topic, we conducted a narrative review aimed at describing all CDSSs identified through searches of Medline dedicated to antimicrobials prescribing from 2019 to 2023. All original research describing a CDSS dedicated to antimicrobials selection, including antibiotics, antivirals, antifungals, and antiparasitic drugs, were eligible. CDSS goals and their potential clinical impacts, as well as characteristics of studies for CDSS evaluation (type of study, population, setting, objectives, and main findings) were extracted. Among the 28 studies included, most (N = 24) were dedicated to antibiotics and 15 were embedded in an electronic health record. Only one CDSS was developed in low- and middle-income countries (LMICs). The main goal of the included CDSSs was to assist clinicians in the selection of antimicrobials. Ten studies included more than 1000 patients or prescriptions, and most of them were implemented in hospitals. Only six studies reported no impact of CDSSs on antibiotic use or compliance with guidelines. CDSSs dedicated to antimicrobial prescribing is an area of increasing activity, with solutions offering the potential to optimize antimicrobial use. Although there is an urgent need to develop CDSSs, CDSS clinical evaluation appears to be an important requirement before implementation. Special efforts are needed to ensure transferability of CDSSs and high adoption, especially in LMICs, while improving awareness through education and training.