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Introduction to AMS

A brief overview of antimicrobial stewardship and the driving principles behind it.
Pills implied to be antibiotics arranged into a repeating pattern
© Freepik 2022.

What is Antimicrobial Stewardship (AMS)?

The definition of AMS varies dependent on the context and reach of those providing it:

a range of definitions for AMS from various institutions: The World Health Organisation is quoted as stating AMS is "A coherent set of actions which promote the responsible use of antimicrobials". The infectious disease society of America and the paediatric infectious disease society states the term AMS " refers to coordinated interventions designed to improve and measure the appropriate use of antimicrobial agents by promoting the selection of optimal antibiotic drug regimens including dosing, duration of therapy and route of administration". Where as NICE, the National Institute for Health and Care Excellence, describes AMS as "an organisational of healthcare-system-wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness"

Whilst definition does vary, the defining principles of AMS remain consistent. AMS consists of a range of interventions which:

Promote responsible use of antimicrobials, limit the development of antimicrobial resistance, improve patient outcomes, and minimise negative consequences of antimicrobial use.

The effective prescription of antimicrobial medicines can be informed by following the 5D’s of antimicrobial prescription. These can be seen in the infographic below.

an infographic showing the 5D's of antimicrobial stewardship. Drug, duration, diagnosis, de-escalation, and dosage.

Antimicrobial drug selection, dosage and treatment duration are informed through the use of diagnostics, followed by informed de-escalation of treatment.

What is an Antimicrobial Stewardship Programme (ASP)?

ASPs are defined by the World Health Organization (WHO) as follows:

"An organisational or system wide health-care strategy to promote the appropriate use of antimicrobials through the implementation of evidence-based interventions". Quote from WHO AMS Toolkit.

Effective ASPs are led by multidisciplinary teams (MDTs), who meet regularly to assure that the established annual action plan is followed. Core members of an MDT should include a lead doctor, a microbiologist, and a pharmacist. Other clinicians may also be included, for example, surgeons, intensivist, primary care practitioners, and representation from the infection control team.

While the MDT will form a committee informing best practice, AMS remains the responsibility of all healthcare staff and should be considered in all aspects of work.

The following section will explore antimicrobial resistance (AMR) in the context of social sciences and how social sciences can inform AMS intervention.

Please click ‘next’ when you are ready to continue, the next section will explore AMR in the context of social sciences.

© BSAC and Imperial College London
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Tackling Antimicrobial Resistance: A Social Science Approach

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