Antibiotics have well-known benefits when used appropriately. However, it has been estimated that up to 50 percent of the antibiotic usage in hospitals is inappropriate.
Clinicians regularly have to make complex decisions about antibiotic use. On one handclinicians should offer optimal therapy for the individual patient under their care; on the other handthey should limit the impact of the antibiotic in order to prevent the selection of resistant pathogens and pathogenic bacteria such as C. difficile.
Not surprisingly, they may be confused by conflicting messages about how the risk for antibiotics overuse can influence their prescribing and how their prescribing can influence the risk for antibiotics overuse. Furthermore, because medical professionals have already established their knowledge, attitudes, and behaviors, it is difficult to change their deeply established views and practice patterns. Significant data support the importance of antibiotic prescribing practices. Prescribing practices may influence the outcome and cost of treatment as well as the risk of some emerging infections (such as C. difficile) and resistant pathogens in the individual patient and the broader environment.
Components of antibiotic prescribing practices include:
- Prevention and control of healthcare-associated infections reducing demand for antibiotics
- Avoidance of unnecessary antibiotic therapy
- Adequacy of the antibiotic(s)
- Timing of antibiotic(s) administration
- Dosing of antibiotic(s)
- Reassessment of antibiotic therapy,
- Length of antibiotic treatment
A growing body of evidence demonstrates that hospital based interventions dedicated to improving antibiotic use, commonly referred to as “Antibiotic Stewardship programs” (ASPs), can both optimize the treatment of infections and reduce adverse events associated with antibiotic use. ASPs incorporate a variety of strategies to optimize antibiotic use in the hospital. Despite currently ASPs are advocated and discussed by national and international organizations, ASPs coverage remains limited to only certain hospitals as well as specific service lines within hospitals.
Improving antimicrobial stewardship in today’s hospitals worldwide requires a systematic approach to prescribe antibiotics appropriately and to prevent healthcare-associated infections. The two go hand-in-hand. it is important that all helthcare workers depend on evidence-based infection and control interventions to reduce demand for antibiotic agents by preventing healthcare-associated infections from occurring in the first place, and making every effort to prevent transmission when they occur. The issues surrounding infection prevention and control are intrinsically linked with the issues associated with the use of antibiotic agents and the proliferation and spread of antimicrobial resistance. The vital work of the infection prevention and control and of the antimicrobial stewardship cannot be performed independently and requires interdependent and coordinated action across multiple and overlapping disciplines and clinical settings.
The preferable means of improving the antimicrobial stewardship is to involve a comprehensive program that incorporates collaboration among various specialties within a healthcare institution. In this context, the direct involvement of prescribers in the ASPs can be highly impactful.
Many antimicrobial stewardship strategies have been shown to be effective. ASPs should select interventions based on local antimicrobial utilization patterns, available resources, and expertise. Multifaceted interventions are more likely to improve antibiotic prescribing practices than simple, passive interventions. Although didactic educational programs alone are generally ineffective, education and awareness are important in implementing antibiotic prescribing practices among prescribers. Education of all health professionals should begin at undergraduate level and be consolidated with further training throughout the postgraduate years. Hospitals are responsible for educating clinical staff about both infection prevention and control and antimicrobial stewardship. Active education techniques, such as academic detailing, consensus building sessions and educational workshops, should be implemented in each hospital worldwide according to its own resources. Efforts to improve education and to raise awareness of the correct use of antibiotics are strongly required at all levels. The direct involvement of all prescribers may be a way to fight the behaviours that block them in this process.