[Correspondence] Hospital antimicrobial stewardship: the way forward – Authors' reply

We thank Charis Marwick and colleagues and Céline Pulcini and Peter Collignon for their comments on our study.1 As stated in the Discussion section, we completely agree that the possibility of uncontrolled studies having observed effects as a result of an underlying secular trend cannot be ignored, and we also recommended the use of controlled interventional designs for future studies. However, we would like to underline that, although some guidance is available on how to design interventions on antimicrobial stewardship,2 specific recommendations about how to select study designs and overcome major bias in assessing antibiotic stewardship programmes (eg, definitions of outcomes or analytical methods) are missing or under development.

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