Antimicrobial stewardship

Antimicrobial stewardship (AMS) refers to coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy, and route of administration. The goal of antimicrobial stewardship is to achieve the best clinical outcomes related to antimicrobial use, minimize toxicity and other adverse events, reduce the costs of health care for infections, and limit the selection for antimicrobial resistant strains.

Overview

Antimicrobial resistance (AMR) is a significant global threat that is exacerbated by the overuse and misuse of antimicrobials. AMS programs aim to combat AMR by ensuring the judicious use of antimicrobials to preserve their effectiveness. These programs are multidisciplinary and involve a collaboration among pharmacists, infectious disease physicians, microbiologists, hospital administrators, and infection control professionals.

Objectives

The primary objectives of antimicrobial stewardship include:

• Optimizing clinical outcomes while minimizing unintended consequences of antimicrobial use, such as toxicity and the selection of antimicrobial resistant organisms.
• Ensuring the right antimicrobial is used for the right infection at the right dose and duration.
• Reducing healthcare-associated infections (HAIs) and the spread of resistant bacteria.
• Preserving the efficacy of current antimicrobials.

Strategies

AMS programs employ various strategies to achieve their objectives, including:

• Development and implementation of antibiotic guidelines and clinical pathways to guide antimicrobial prescribing.
• Antimicrobial susceptibility testing to tailor antimicrobial therapy to the specific pathogens causing an infection.
• Dose optimization to ensure effective drug exposure and reduce the risk of resistance.
• Infection control measures to prevent the spread of resistant organisms.
• Education and training of healthcare professionals on the principles of antimicrobial stewardship and resistance.
• Monitoring and feedback on antimicrobial use and resistance patterns.

Implementation

Implementing an effective AMS program requires the establishment of a multidisciplinary team, including leadership support from hospital administration. Key components include:

• Establishing policies and procedures for antimicrobial use.
• Regular review of antimicrobial prescribing and feedback to prescribers.
• Integration of information technology systems for tracking and reporting antimicrobial use and resistance patterns.
• Education and training programs for healthcare providers.

Challenges

Challenges to antimicrobial stewardship include:

• Lack of awareness and understanding of AMR among healthcare providers and the public.
• Insufficient resources and support for AMS programs in many healthcare settings.
• The need for global coordination and sharing of best practices in AMS.

Conclusion

Antimicrobial stewardship is a critical component in the fight against antimicrobial resistance. By promoting the appropriate use of antimicrobials, AMS programs can improve patient outcomes, reduce healthcare costs, and preserve the effectiveness of these vital drugs for future generations.