Core Interventions

In this video, Laila Alwadah discusses core antimicrobial stewardship (AMS) strategies that a hospital may implement.

There are multiple strategies that may be chosen – there are strategies that can address gaps in antibiotic prescribing at a front end or before prescription and strategies that are done at a back end or post prescription. In general, in a hospital setting, it is advised to implement a hybrid of both interventions.

Another way of thinking about antimicrobial stewardship interventions is to classify them as either:

1. Structural interventions (e.g. using rapid diagnostics or inflammatory marker guided approach for antibiotic prescription).

2. Persuasive interventions which includes the prospective audit and feedback approach.

3. Restrictive interventions such as the pre-authorisation approach.

4. Enabling interventions which includes development of facility specific treatment guidelines followed by education and adherence monitoring.

5. Intervention bundles which is a combination of different interventions, for example a bundle containing guidelines, education, face-to-face feedback to prescribers and so on.

Evidence demonstrates that prospective audit and feedback (sometimes referred to as post prescription review and pre-authorisation) are the two most effective antibiotic stewardship interventions in hospitals.

The practice of AMS is complex, and guidelines advise to tailor the used strategies to fit the needs of and infrastructure of each institution – there is no “one size fits all” when it comes to ASPs. The overall goal is to use antibiotics appropriately, so it is useful to spend time understanding the local culture and start with addressing “low hanging fruit” before aiming for more complex issues.

It is important to start small, have a focused annual direction for your program, celebrate your achievements, maintain them, and build upon them every year. Every single antibiotic adjustment matters.

Do you have an example of an AMS implementation in your healthcare setting that worked well?