5x5 Antimicrobial Audit


The 5x5 Antimicrobial Audit is an initiative of the Clinical Excellence Commission that aims to improve communication and selection of empirical antimicrobial therapy among clinical teams.


The 5x5 Antimicrobial Audit provides a platform for introducing regular, frequent and directed measurement and reporting of antimicrobial prescribing indicators in NSW local health districts and networks.

The auditing process encourages clinically appropriate interventions where indications are unclear and/or empiric antimicrobial prescribing is found to be non-concordant with local guidelines.

The 5x5 Antimicrobial Audit also facilitates rapid feedback of ward or unit-level antimicrobial prescribing indicators by providing tools and support to enable simple reports to be generated and discussed with prescribers.


The 5x5 Antimicrobial Audit and its supporting components have been developed by the CEC, based on the work of the Scottish Antimicrobial Prescribing Group.

The 5x5 Antimicrobial Audit is a sustainable model of audit, intervention and feedback designed to improve the quality of antimicrobial prescribing in targeted areas of clinical practice.

The methodology of the 5x5 Antimicrobial Audit involves ongoing data collection of small sample sizes, with trained auditors required to answer up to 5 questions in 5 or more patients per week. Two process measures for the audit are based on a prescribing indicator developed by the Scottish Antimicrobial Prescribing Group, and are defined as:

  1. Documentation of an indication for antimicrobial therapy
  2. Concordance with guidelines (or non-concordance with a documented reason).

Across 2014/15, fifteen facilities from NSW local health districts and networks were involved in a 12 month pilot project for the 5x5 Antimicrobial Audit. This project provided cumulative data from over 4600 audit records and prompted over 1000 point-of-care interventions. Results of the pilot provide strong evidence that implementation of this initiative contributes to improvements in the quality of antimicrobial prescribing in wide variety of hospital inpatient settings. The 5x5 Antimicrobial Audit pilot project was evaluated in July 2015 and the 5x5 Antimicrobial Audit resource package has been updated based on the project’s key learnings.

If you have implemented, or are considering implementation of the 5x5 Antimicrobial Audit at your facility, the QUAH program team is available to provide advice. Please direct all correspondence to CEC-HAI@health.nsw.gov.au.


Key Dates

Pilot Sites

Implementation Sites


Further Details

For more information, please refer to the Audit User Guide and other resources on the 5x5 Antimicrobial Audit webpage:

Key References

  1. Malcolm W, Nathwani D, Davey P, Cromwell T, Patton A, Reilly J, Cairns S, Bennie M. From intermittent antibiotic point prevalence surveys to quality improvement: experience in Scottish hospitals. Antimicrob Resist Infect Control. 2013 Jan 15;2(1):3.
  2. Nathwani D, Sneddon J, Malcolm W, Wiuff C, Patton A, Hurding S, Eastaway A, Seaton RA, Watson E, Gillies E, Davey P, Bennie M; Scottish Antimicrobial Prescribing Group. Scottish Antimicrobial Prescribing Group (SAPG): development and impact of the Scottish National Antimicrobial Stewardship Programme. Int J Antimicrob Agents. 2011 Jul;38(1):16-26. Epub 2011 Apr 22.
  3. Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, O’Brien MA, Johansen M, Grimshaw J, Oxman AD.Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012 Jun 13;6:CD000259.


Evette Buono
Program Leader, Antimicrobial Stewardship
02 9269 5581

Dr Paul Curtis
Director, Clinical Governance
02 9269 5569

Page Top | Added: 2 June 2014 | Last modified: 9 November 2015

Evette Buono
Program Leader, Antimicrobial Stewardship
02 9269 5581