What can be done?

The Infectious Diseases Society of America describes antimicrobial stewardship as:

“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. Antimicrobial stewards seek to achieve optimal 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.”

While anyone who prescribes antibiotics has a responsibility to prescribe according to stewardship principles, stewardship programmes in healthcare organisations are usually directed by a multidisciplinary stewardship team. The make-up of this team depends on local resources. Suggested members include medical microbiologists and/or infectious disease physicians, antimicrobial pharmacists, infection control nurses, hospital epidemiologists and information systems specialists. The work of a stewardship team divides up into two major areas, surveillance of prescribing practice and clinical outcomes, and the design and implementation of interventions aimed at optimal antibiotic prescribing.

Surveillance includes measuring processes such as antibacterial use (various measures of quantities and measures of adherence to antibiotic prescribing guidelines), ecological impacts (antibiotic resistance measures and Clostridium difficile infection numbers) and clinical outcomes (morbidity and mortality rates). Interventions have been divided up into three main categories-structural, persuasive and restrictive (Davey P et al. Cochrane database of systematic reviews 2013).

An update of this paper by Davey et al is available in “See also” below.