Although most physicians are aware of the problem of antimicrobial resistance, most underestimate this problem in their own hospital and prescribe inappropriately antibiotics.
Antimicrobial stewardship program (ASP) is an emerging strategy designed to optimize outcomes and reduce the emergence of resistant organisms. Educating clinicians in the appropriate use of antibiotics is an essential part of antimicrobial stewardship.
The best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy and routine clinical practice.
Since physicians are primarily responsible for the decision to use antibiotics, educating them and changing the attitudes and knowledge that underlie their prescribing behavior are crucial for improving antimicrobial prescription. The ultimate goal of an ASP should be to stimulate a behavioral change in prescribing practice. Educational interventions should include any attempt to persuade physicians to modify their clinical practice.
Promotion of ASPs across clinical practice is crucial to their success to ensure standardization of antibiotic use within an institution. We propose that the best means of improving antimicrobial stewardship should involve collaboration among various specialties within a healthcare institution including prescribing physicians.
Successful ASPs should focus on collaboration between all healthcare professionals to shared knowledge and widespread diffusion of practice. Involvement of prescribing physicians in ASPs may rise their awareness on antimicrobial resistance.
The best organization of ASPs should provide all professionals involved in both prevention and treatment of infections including epidemiologists, infection control specialists, infectious diseases specialists, microbiologists, clinical pharmacologists, hospital pharmacists, surgeons, intensivists, anesthesiologists and nurses.
Only by a cohesive approach with a direct involvement of prescribing physicians the battle against the inappropriate use of antibiotics in hospitals worldwide may be won.
Massimo Sartelli
Global Alliance for Infections in Surgery 