The Role of Antibiotic Stewardship in Promoting Appropriate Antibiotic Use
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Antibiotics are one of the most significant medical discoveries in human history. The widespread use of antibiotics has resulted in the emergence of antibiotic-resistant pathogens. This fact, coupled with the paucity of new antibiotic developments, has spurred efforts to combat antibiotic resistance. One of the most critical components of these efforts is antibiotic stewardship, a multidisciplinary endeavor, employing a collection of interventions in a variety of health care settings with the aim of promoting appropriate utilization of antibiotics. This article describes antibiotic stewardship programs and key practices used to minimize the development and spread of antibiotic-resistant pathogens including the optimization of antibiotic pharmacokinetics and pharmacodynamics, the application of rapid diagnostic tools, and the use of computerized provider order entry tools.Keywords:
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Antimicrobial resistance is a growing public health threat that at times may appear to be unsolvable.However, in the last few years, great advances have been made to address this issue in Canada and around the world.Our Federal Action Plan on Antimicrobial Resistance and Use in Canada has identified three pillars to address antimicrobial resistance: surveillance, stewardship and innovation.In this supplement are examples of successful stewardship programs for the community, physicians and health care organizations; there are many more.Given that we know successful stewardship programs are possible, it is important to continue this work across the country.Each success helps and multiple successes can create a synergistic effect that can lead to a change in patient expectations and prescribing patterns.Our antimicrobials are a precious resource.It is well worth the effort to contribute to this synergy and build a culture of stewardship so that antimicrobials will continue to be effective for generations to come.
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Inappropriate antibiotic use and associated consequences, including pathogen resistance and
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The opioid stewardship model is born out of the antimicrobial stewardship model, and thus there are many shared characteristics. Both opioid stewardship and antimicrobial stewardship are based on the principle that there is an indication for a particular medication in the right patient at the right time. As antimicrobial stewardship is in a later stage of development, looking at the two in parallel can lead to interesting learning and development opportunities for opioid stewardship. Two requirements of antimicrobial stewardship that need to be applied to opioid stewardship for optimum outcomes are the requirement for dedicated resources, more specifically a trained pharmacist, and a declaration that opioid stewardship is essential for health-system accreditation.
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Abstract United States guidance for hospital antibiotic stewardship has emphasized prospective audit and feedback and prior authorization of select antibiotics as core interventions. These remain the most common interventions implemented by stewardship programs. Although these approaches have been shown to reduce unnecessary antibiotic use, they incorrectly put the onus for appropriate antibiotic use on the stewardship team rather than the prescribing clinician. We propose that a primary focus of stewardship programs should be implementation of broader interventions that engage frontline clinicians and equip them with tools to integrate antibiotic stewardship into their own daily practice, thus reducing the need for day-to-day stewardship team oversite. We discuss a framework of broader interventions and policies that will facilitate this paradigm shift.
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We wholeheartedly agree with Dik et al. ([1][1]) that a combined approach is the future of stewardship and commend the authors for their innovative model. Incorporating infection control and epidemiology into an integrated diagnostic and antimicrobial stewardship model further capitalizes upon the
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This chapter focuses on stewardship in the primary care and long-term care settings. Antibiotic prescribing in the community accounts for 80% total antibiotic prescribing and approximately 75% of this is for acute respiratory tract infections, many of which are viral. There is also significant variation in prescribing practices that is not explained by differences in presenting patients. These factors suggest that antimicrobial stewardship programmes are necessary. This chapter identifies the components of stewardship that have been successful in influencing antibiotic prescribing in primary care and shares local experiences with practical examples. The lack of UK evidence about antimicrobial stewardship in long-term care facilities is discussed, along with successful interventions from overseas. Challenges within these settings are highlighted, including patient demand, lack of access to microbiological and diagnostic tools, competing targets, time pressures, and clinical uncertainty.
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