Discharge Antibiotic Plan & Transition-of-Care Note

Author/Service: [Author name and service]
Date/Time Signed: [YYYY-MM-DD HH:MM]
Admission Date: [YYYY-MM-DD]
Discharge Date: [YYYY-MM-DD]
Disposition: [home / SNF / rehab / LTACH / other]
Antibiotic Delivery Mode: [oral / OPAT / dialysis-unit dosing / infusion center]
Receiving Facility/Agency: [Facility/Agency name or "Not applicable"]

Primary Follow-up Clinician(s):

• PCP: [PCP name or "Not established"] — [Urgent contact method]
• Infectious Diseases Clinician: [ID clinician name or "Not established"] — [Urgent contact method]

Antibiotic Plan at a Glance

Final Infectious Diagnosis: [Syndrome/anatomic site with organism if known] — [Confirmed / Probable / Possible]

Definitive Regimen:

Indication	Drug	Dose/Route/Frequency	Start Date	Stop Date	Total Duration	Notes
[Indication]	[Drug name]	[Dose / Route / Frequency]	[YYYY-MM-DD]	[YYYY-MM-DD]	[Duration in days]	[Duration anchor; dose adjustments; IV-to-PO criteria]

(Add rows for each concurrent or sequential antibiotic. Use absolute dates. Specify how duration was calculated—e.g., from source control, first negative blood culture, procedure date.)

Contingencies: [If susceptibilities/cultures pending: who will act on results and anticipated changes. If intolerance occurs: preferred alternative or "Contact ID/PCP before changes."]

Antibiotics Discontinued: [None / "Antibiotics STOPPED at discharge" with rationale] (If specific inpatient agents were stopped, list them with brief rationale.)

Infection Course Summary

(Provide concise synthesis explaining why the plan above is correct. Keep to 1–2 short paragraphs or 5–8 bullets. Omit for straightforward infections where Plan at a Glance is self-explanatory.)

• [Presenting infectious concern and context]
• [Key diagnostics anchoring diagnosis]
• [Empiric-to-definitive therapy rationale]
• [Source control procedures and completeness]
• [Clinical response and stability at discharge]

Microbiology & Diagnostics

• Culture: Source: [Source] | Collected: [YYYY-MM-DD] | Result: [Organism or no growth; infection vs colonization] | Key susceptibilities: [Relevant findings only]

(For bacteremia, document clearance date if used for duration calculation. If no cultures obtained, state "Cultures not obtained" with reason.)

Imaging/Procedures: [Modality, date, and key finding] (Include only when it anchors diagnosis or duration—e.g., osteomyelitis imaging, echocardiography.)

Pending Results:

• [Pending item]: Responsible: [Clinician/team] — Notification plan: [How results will be communicated and acted upon]

Source Control & Devices

(Include only if procedures were performed or devices affect therapy.)

• Procedure: [Procedure name] — [YYYY-MM-DD] — [Completeness of source control; residual hardware/collections]
• Vascular access: [PICC / midline / tunneled catheter] — [Placement date] — [Line care managed by:] — [Removal date/criteria]

Safety Checks

Allergies: [Antibiotic allergies with reaction type (anaphylaxis / rash / GI upset / unknown) or "No known antibiotic allergies"]

Renal/Hepatic Dosing: [Recent creatinine/eGFR with date; dose adjustment triggers or "No adjustments required"]

Drug Interactions: [High-impact interactions requiring action (warfarin adjustment, QT monitoring, chelation spacing) or omit if none]

Adverse Effect Monitoring: [Agent-specific risks (C. difficile, marrow suppression, nephrotoxicity, hepatotoxicity) and monitoring plan]

Monitoring Plan

(If no antibiotics continued, state "No antibiotic monitoring required.")

• Test: [CBC / CMP / LFTs / Drug level] — Frequency: [Cadence with start date] — Responsible: [Clinician/team] — Action threshold: [Values/findings prompting action]

Follow-up Plan

Appointments:

• ID follow-up: [Scheduled date or time window] (If not arranged, document barriers and interim plan.)
• PCP follow-up: [Scheduled date or timeframe]
• Specialty follow-up: [Surgery/wound care as applicable]

Test of Cure: [Planned assessments (repeat imaging, inflammatory markers); who orders/reviews; timing] (Distinct from toxicity monitoring.)

Escalation Criteria: [Symptoms/signs/lab abnormalities requiring urgent reassessment; whom to contact]

Handoff Verification

(Include for OPAT, complex regimens, or pending critical results.)

• PCP notified: [yes / no] — [Method] — [Date]
• ID clinic notified: [yes / no] — [Method] — [Date]
• Receiving facility handoff: [Completed / Not applicable] — [Contact person]
• Infusion pharmacy contacted: [yes / no / not applicable] — [First dose timing]
• Medication access: [Prior authorization status; pharmacy fill confirmed; first dose timing]

Signature: [Clinician name, credentials, direct contact]
Antibiotic plan addendum to discharge summary. (Include if functioning as addendum.)