Antimicrobial Stewardship (AMS): Optimizing Antibiotic Practices

Antimicrobial stewardship is the optimization of antimicrobial use to ensure their effectiveness and preserve them for future generations. It involves avoiding unnecessary use of antimicrobials, prescribing the right antibiotic for the patient, using the correct dose and route of delivery, and prescribing antibiotics for the appropriate duration.

Importance of Antimicrobial Stewardship:

1. Combatting antimicrobial resistance: Antimicrobial resistance is a global public health emergency that threatens modern medicine. By implementing stewardship programs, healthcare professionals can help curb the emergence of resistance and preserve the effectiveness of antimicrobials.
2. Patient safety: Appropriate use of antimicrobials reduces the risk of adverse effects and complications associated with their use. Stewardship programs ensure that patients receive the right antibiotic at the right time, improving patient outcomes and safety.
3. Cost-effectiveness: Unnecessary use of antimicrobials can lead to increased healthcare costs. By optimizing antimicrobial use, stewardship programs can help reduce healthcare expenses while maintaining quality patient care.
4. Public health impact: Antimicrobial resistance affects not only individual patients but also the broader community. By implementing stewardship programs, healthcare providers contribute to the overall public health by reducing the spread of resistant infections.

Antimicrobial stewardship programs can optimize antibiotic use and reduce the incidence of antibiotic-resistant infections through various strategies and interventions:

• Clinician education:Providing education and training to healthcare professionals about appropriate antibiotic use, including the selection of optimal drug regimens, dosing, duration of therapy, and route of administration.
• Formulary Optimization: Developing and implementing guidelines for antibiotic use, including formulary restrictions and preferred antibiotic choices based on local resistance patterns and clinical guidelines.
• Antibiotic Use Restrictions: Implementing policies and protocols that restrict the use of certain antibiotics to specific indications or conditions, reducing unnecessary or inappropriate use.
• Prospective Audit with Intervention and Feedback:Regularly reviewing antibiotic prescriptions and providing feedback to prescribers, identifying opportunities for improvement and offering alternative treatment options when necessary.
• Optimization of Dosing and Administration: Ensuring that antibiotics are prescribed at the right dose and administered through the most appropriate route, considering factors such as patient characteristics, site of infection, and pharmacokinetics/pharmacodynamics.
• Streamlining and De-escalation: Evaluating the need for combination therapy and de-escalating treatment when appropriate, reducing the risk of antibiotic resistance and minimizing the potential for adverse effects.
• Switching from Intravenous to Oral Therapy: Encouraging the early transition from intravenous to oral antibiotics when patients are clinically stable, reducing the duration of hospital stays and associated risks.
• Appropriate Duration of Therapy: Promoting the use of evidence-based guidelines to determine the optimal duration of antibiotic therapy for different infections, avoiding unnecessary prolonged treatment.
• Specific Treatment Pathways: Developing and implementing treatment pathways based on clinical guidelines and local epidemiology, ensuring standardized and evidence-based approaches to antibiotic use.

Role of clinicians in curbing the emergence of antimicrobial resistance:

1. Appropriate prescribing: Clinicians should prescribe antimicrobials only when necessary and based on evidence-based guidelines. They should avoid prescribing antibiotics for viral infections, where they are ineffective. By avoiding unnecessary use, clinicians can help reduce the selective pressure that drives antimicrobial resistance.
2. Choosing the right antibiotic: Clinicians should select the most appropriate antibiotic for each patient based on factors such as the type of infection, susceptibility patterns, and patient-specific factors. Choosing the right antibiotic helps ensure effective treatment and minimizes the risk of resistance.
3. Optimizing antibiotic use: Clinicians should prescribe antibiotics at the correct dose, route of administration, and duration. They should also consider de-escalation, which involves narrowing the spectrum of antibiotics once the causative organism is identified. Optimizing antibiotic use helps minimize the development of resistance.
4. Infection prevention and control: Clinicians should follow infection prevention and control measures to prevent the spread of infections. This includes proper hand hygiene, using personal protective equipment, and implementing strategies to reduce healthcare-associated infections. By preventing infections, clinicians can reduce the need for antimicrobial treatment.
5. Collaboration with antimicrobial stewardship programs: Clinicians should actively participate in antimicrobial stewardship programs within their healthcare settings. These programs provide guidance, education, and monitoring to promote appropriate antimicrobial use. By collaborating with these programs, clinicians can contribute to the overall efforts in curbing antimicrobial resistance.
6. Patient education: Clinicians can educate their patients about the appropriate use of antimicrobials, including the importance of completing the full course of antibiotics and not sharing or saving antibiotics for future use. Patient education helps promote responsible antibiotic use and reduces the risk of resistance.

Conclusion

Antimicrobial stewardship programs are shown to optimize antibiotic use, reduce the incidence of antibiotic-resistant infections, shorten hospital stays, and lower drug acquisition costs. Antimicrobial stewardship plays a crucial role in preserving the effectiveness of antimicrobials, improving patient outcomes, and addressing the global challenge of antimicrobial resistance.

The strategies employed by these programs include clinician education, formulary optimization, antibiotic use restrictions, and optimization of dosing and administration. Effective implementation requires collaboration between various healthcare professionals. Overall, antimicrobial stewardship plays a crucial role in improving patient care and ensuring a sustainable antibiotic future.

(Author is a Medico, educator and columnist. He has done Certification in Antimicrobial Stewardship from Stanford University School of Medicine (USA). Feedback: [email protected])