Purpose of review: To explore recent developments in computerized evidence-based guidelines and decision support systems that have been designed to improve the effectiveness and efficiency of antibiotic prescribing. Recent findings: The most frequently utilized decision support systems are electronic guidelines and protocols, especially for empirical selection of antibiotics. The majority of decision support systems result in improvement in clinical performance and, in at least half of the published trials, in patient outcomes. Despite the reported successes of individual applications, the safety of electronic prescribing systems in routine practice has been identified recently as an issue of potential concern. Bioinformatics-assisted prescribing may contribute to reducing the complexities of prescribing combinations of antimicrobials in the era of multidrug resistance. Summary: The reemerging interest in prescribing decision support reflects the recent change in emphasis from support for diagnostic decisions towards support for patient management and from systems targeting a broad range of clinical diagnoses to task-specific and condition-specific decision aids.