From the Guidelines
Antibiotic Stewardship is a coordinated effort to improve and measure the appropriate use of antibiotic agents by promoting the selection of the optimal antibiotic drug regimen, including dosing, duration of therapy, and route of administration.
Key Components
- The primary goal of Antibiotic Stewardship is to optimize clinical outcomes while minimizing unintended consequences, such as adverse events, selection of pathogenic organisms, and emergence of resistance 1.
- Appropriate antimicrobial prescribing requires the right diagnosis, drug, dose, duration, and de-escalation (5Ds of stewardship) 1.
- Antibiotic Stewardship programs (ASPs) are best led by infectious disease physicians with additional stewardship training 1.
Implementation
- Preauthorization and/or prospective audit and feedback are core components of any stewardship program, and programs should decide whether to include one strategy or a combination of both based on facility-specific resources 1.
- ASPs can be implemented in various settings, including emergency departments, nursing homes, and skilled nursing facilities 1.
Benefits
- The benefits of Antibiotic Stewardship include improved patient outcomes, reduced adverse events, improvement in rates of antibiotic susceptibilities, and optimization of resource utilization 1.
From the Research
Definition of Antibiotic Stewardship
- Antibiotic stewardship refers to a multifaceted approach to optimize prescribing of antimicrobial agents, aiming to reduce costs, optimize therapeutic outcomes, and reduce antimicrobial resistance 2, 3, 4, 5.
- It involves selecting an appropriate drug, optimizing its dose and duration to cure an infection, while minimizing toxicity and conditions for selection of resistant bacterial strains 2.
Importance of Antibiotic Stewardship
- Antibiotic resistance is a major health threat, and antibiotic stewardship has been shown to be effective in reducing antimicrobial resistance, adverse drug effects, mortality, and healthcare costs 3, 4, 5.
- The vast majority of antibiotic prescriptions are dispensed in ambulatory care settings, making this a critical target for stewardship programs 3.
Strategies for Antibiotic Stewardship
- Several strategies have been proposed to improve antibiotic use, including prescriber education, formulary restriction, prior approval, streamlining, antibiotic cycling, and computer-assisted programs 2, 4.
- A comprehensive program that incorporates multiple strategies and collaboration among various specialties within a given healthcare institution is likely to be the most effective means of improving antimicrobial stewardship 2, 4.
Benefits of Antibiotic Stewardship
- Antibiotic stewardship programs have been shown to reduce antimicrobial use, mortality, Clostridium difficile and other healthcare-associated infections, hospital length of stay, and bacterial resistance 4, 5.
- Reductions in antimicrobial resistance are the most elusive, but some interventions have been shown to reduce overall antimicrobial selective pressure and impact resistance rates in individual institutions 5.