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What is Antimicrobial Stewardship?

In this article Dr Jacqui Sneddon highlights the key elements of antimicrobial stewardship
Plastic mulitcoloured letters spelling care.

The word stewardship means ‘taking care’ so in this respect it means taking care of antibiotics.

In practical terms antimicrobial stewardship is a programme of activities to improve how we use antibiotics in the hospital and community settings. Antimicrobial stewardship can reduce the unnecessary use of antibiotics and also ensure that when antibiotics are required they are used correctly to treat bacterial infections.

The main challenge in primary care, is the use of antibiotics for self-limiting infections caused by viruses, or in some cases bacteria, such as upper respiratory tract infections (coughs, colds, flu, sore throat).

When antibiotics are required to treat a bacterial infection in hospital or in the community it is important to remember the 5 “Rs”:

5 Rs: Right choice for the specific infection; Right dose for optimum effect; Right frequency to ensure we reach the MIC for the antibiotic; Right route usually oral or IV but must be switched back to oral when appropriate; Right duration - long enough to treat the infection but not too long to lead to resistance

MIC = Minimum Inhibitory Concentration

Here are some interesting facts about antimicrobial prescribing which provide a useful 30% rule (compiled from documents in downloads):

  • ~ 30% of all hospitalised inpatients at any given time receive antibiotics
  • Over 30% of antibiotics are prescribed inappropriately in the community
  • Up to 30% of all surgical prophylaxis is inappropriate
  • ~ 30% of hospital pharmacy costs are due to antimicrobial use
  • 10-30% of pharmacy costs can be saved by antimicrobial stewardship programmes

A key objective, therefore, of antimicrobial stewardship is to develop and ensure that prescribers follow local evidence-based antibiotic policies which give advice on which antibiotics to use for common infections which will:

  • Ensure patients receive optimal treatment
  • Protect the effectiveness of broad-spectrum antibiotics by restricting their use
  • Reduce inappropriate use of antibiotics for self-limiting infections such as coughs and colds
  • Ensure that healthcare professionals, patients and the public understand the need to use antibiotics prudently

You can find lots of useful ideas about how to undertake Antimicrobial Stewardship in this Practical Guide to Antimicrobial Stewardship in Hospitals.

Ideally there should be a supporting structure, such as the one shown below, for antimicrobial stewardship within a hospital.

Central Antimicrobial Stewardship Team who liaise with key committees to disseminate information and feedback to them. All committees must feedback to the Medical Director, Infection Control Manager and the Chief ExecutiveAdapted from Nathwani et al, J Antimicrob Chemo, 2006, 57: 1189-1196 (Click to expand)

This should include a multi-professional team tasked with delivering an antimicrobial stewardship programme which meets regularly and has an annual action plan. The core members should be a lead doctor, microbiologist, antimicrobial pharmacist but may also include other clinicians such as surgeon, intensivist, primary care practitioner, and infection control team representative.

However, in all clinical settings antimicrobial stewardship should be everyone’s business.

The doctor’s role in antimicrobial stewardship is to prescribe antibiotics following local policy and to seek specialist advice if required.

The nurse’s role is to ensure antibiotics are prescribed as per policy and to administer antibiotics safely and in a timely manner, with prompt review and therapeutic drug monitoring and adverse drug reaction monitoring.

Pharmacists should also ensure that antibiotics are prescribed as per policy, provide prompt review and advise on therapeutic drug monitoring results as well as monitor for adverse drug reactions.

If you would like to learn more about Antimicrobial Stewardship, this FutureLearn course on Antimicrobal Stewardship offers practice based learning for healthcare professionals.

In the comments below, please let us know:

  • Which of the components mentioned by Dr Sneddon are present in your place of work?
  • In light of these components, how could the stewardship programme at your workplace be improved?
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Challenges in Antibiotic Resistance: Point Prevalence Surveys

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