What are the principles of antibiotic stewardship for treating common infections?

Principles of Antibiotic Stewardship for Treating Common Infections

Antibiotic stewardship programs (ASPs) must implement a structured approach that optimizes antibiotic use, improves patient outcomes, reduces antimicrobial resistance, and prolongs the lifespan of existing antibiotics while reducing healthcare costs. 1

Core Principles of Antibiotic Stewardship

1. Responsible Use of Antimicrobials

• Use antibiotics only for bacterial infections, not viral infections like the common cold 2
• Select optimal drug regimens based on:
  • Appropriate drug selection (using the narrowest spectrum effective agent)
  • Correct dosing, formulation, and route of administration
  • Proper timing and duration of therapy 3
• Use antimicrobials only when susceptibility is confirmed, with exceptions for cases where resistance can be overcome (e.g., using clavulanic acid to inhibit β-lactamase) 3

2. Implementation of Specific Interventions

Syndrome-Specific Guidelines

• Develop facility-specific guidelines for common infections 3
• Target specific infectious disease syndromes rather than individual antibiotics 3
• Examples of successful targeted interventions:
  • Skin and soft tissue infection protocols (resulting in 3-day reduction in therapy length and 30% reduction in broad-spectrum antibiotic use) 3
  • Community-acquired pneumonia interventions (increasing appropriate therapy from ~55% to >90%) 3
  • Asymptomatic bacteriuria protocols (reducing unnecessary urine cultures and treatment) 3

Categorization of Antibiotics

• WHO recommends categorizing antibiotics into Access, Watch, and Reserve groups with clear stewardship implications for each category 3
• This approach helps prioritize first and second-choice antibiotics for empiric treatment 3

3. Tracking and Reporting

• Monitor antibiotic prescribing patterns and resistance trends 1
• Measure key outcomes:
  • Clinical outcomes: mortality, length of stay, readmission rates
  • Process measures: appropriateness of prescribing, adherence to guidelines
  • Adverse events: C. difficile infection rates, antibiotic resistance patterns 1
• Provide regular feedback to prescribers on their antibiotic prescribing practices 3

Practical Implementation Strategies

Empiric Treatment Approach

• Base empiric treatment on presumptive diagnosis of common infections 3
• Select antibiotics based on local resistance patterns and patient risk factors 3
• Transition from empiric to targeted therapy once culture results are available 3

Optimizing Treatment Duration

• Use the shortest effective duration of antibiotic therapy 3
• Implement early IV-to-oral conversion protocols when appropriate 1
• Avoid unnecessarily prolonged courses (e.g., 10-day courses when shorter durations are effective) 4

Educational Components

• Provide ongoing education to healthcare providers about appropriate antibiotic use 1
• Focus on teaching principles of microbiology, infectious diseases, and clinical pharmacology 5
• Target education at undergraduate and postgraduate levels 5

Common Pitfalls to Avoid

• Using broad-spectrum antibiotics when narrow-spectrum agents would be effective 6
• Failing to de-escalate from broad-spectrum empiric therapy to targeted treatment 6
• Treating asymptomatic colonization rather than true infection 3
• Prescribing antibiotics for viral infections 2
• Skipping doses or not completing the full course of necessary therapy 2

Population-Specific Considerations

• Pediatric populations require weight-based dosing and have different common infections and pathogens 1
• Adult populations have more comorbidities, drug interactions, and diverse infection types 1
• Elderly and immunocompromised patients may require special considerations for empiric therapy 3

By implementing these principles of antibiotic stewardship, healthcare facilities can optimize antibiotic use, improve patient outcomes, and combat the growing threat of antimicrobial resistance.