Presentation of Antibiotic policies and stewardship

2.  The aim for introducing an antibiotic policy is to
encourage rational prescribing which is based on
knowledge of pharmacology, efficacy, safety and cost.

3. Antibiotic control programmes should promote good
antibiotic stewardship, such as controlling overall
antibiotic consumption and de-escalating or narrowing
antibiotic treatment whenever necessary.
Antibiotic prescribers should be aware of the possibilities
of ‘collateral damage’ (e.g. infection / colonization by
MDR organisms), that may result from antibiotics
overuse

4. Cost :
Antibiotics account for 2-25% of all prescriptions, 2-
21% of the total market value of drugs in a single
country and up to 50% of the drug budget in a hospital

5. Antibiotic Resistance :
 Unnecessary prescribing of antimicrobials carries risk
for the patient and the environment as a result of
selection of MDR organisms under antibiotic pressure

6. Uncontrolled use of antibiotics, particularly in
developing countries where antibiotics are sold freely
over the counter has contributed to the selection and
proliferation of multiply resistant organisms.

7. Implementation of antibiotic policies
The first aim should be to change medical practice,
which may have a variety of secondary aims (e.g.
reducing drug costs, improving quality of prescribing,
limiting drug resistance).
antibiotic policies should address the complex process
of prescribing an antibiotic (need, selection, dosing
regimen, route of administration, information to assess
outcome)

8.  The policy will succeed if the results of implementation
are audited and the policy is adapted in response to the
information collected.
requires leadership from senior hospital management and
dedicated time from enthusiastic infection specialists
and pharmacists.

9. There have been few studies of different methods of
implementation:
1) Educational activities to judiciously use antibiotics
have been successful e.g. promote use of cheaper
alternative agents.
2) improve dosing of parenteral antibiotics.

10. Antibiotic Stewardship
is the practice of monitoring and improving the
appropriate use of antibiotics by promoting best
practice in the choice of regimen, duration, and route.

11.  changing prescribing practices to narrower agents is
associated with a decline in resistant organisms such
as MRSA.

12. stewardship programme
includes:
 • guidance on when to start antibiotics and locally
developed treatment guidelines that balance the use of
focused- spectrum agents with clinical safety.
 • education of the importance of taking appropriate
cultures prior to initiating therapy, so that a switch can
be made from broad empirical therapy with confidence.
• regular review of the diagnosis (are antibiotics really
required), antibiotic given (switch to narrower agent once
culture results available), route (can a switch to oral be
made), and stop date (shortest possible course).

13. • rigorous enforcement of single- dose surgical
prophylaxis guidelines.
• bedside review of those patients on broad agents by
infection specialists to assess clinical indication and
need.
• audit of antibiotic use to identify areas requiring
specific interventions.

14. Thank you