Professional Documents
Culture Documents
Antibiotic stewardship is a systematic and consistent approach to promoting the correct and
prudent use of antibiotics. It not only promotes the correct and effective use of antibiotics but also
advocates against the unnecessary use of antibiotics. Although specifically geared to prescribers,
i.e. medical doctors, there is also an important role for the public in terms of lowering their
expectations for antibiotics when they are not necessary.
Use of antibiotics only where necessary or where there is likely to be a bacterial infection
Antibiotic use directed towards the most likely pathogen, i.e. the prescriber bears in mind
the most likely cause of the infection and therapy subsequently adjusted, if necessary,
based on microbiological culture results
Antibiotic use guided by recent microbiological reports from specimens taken from the
patient
History of allergy and potential side effects of antibiotic prescribed is taken into
consideration
The therapy is given by the appropriate route, intravenously if acutely ill, orally if not so
acutely ill, and the dose is correct
The antibiotics are accompanied by other approaches such as surgical drainage in the
case of an abscess and removal of an intravenous line in case of catheter-associated
bloodstream infection.
The use of an antibiotic when not indicated, i.e. to treat a viral infection
The use of a particular antibiotic to which it can be anticipated that the pathogen is
resistant, e.g. a metronidazole to treat aerobic Gram negative bacillary infection
The wrong choice of antibiotic or the administration of the antibiotic by the wrong route
The use of multiple agents which have similar spectrums of activity. For example the use
of co-amoxiclav and metronidazole to treat a possible anaerobic infection
7. Patient expectations, i.e. the patient has come to the general practitioner and he or she
expects an antibiotic in return
Give some examples of antibiotic resistant organisms in the community that have partly emerged
due to inappropriate antibiotic use?
Examples include Streptococcus pneumoniae increasing resistance to penicillin and to other antibiotics such as
the cephalosporins.
Beta haemolytic streptococci Group A, resistant to macrolides such as erythromycin and also
increasing resistance to tetracycline.
Mycobacterium tuberculosis, resistant in some countries to many agents resulting in multi-drug
resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB).
Eschericha coli, most strains of E. coli even in the community are ampicillin resistant.
Increasing levels of resistance to quinolone, cephalosporin and aminoglycoside antibiotics.
MRSA
VRE
Increased use of empiric broad spectrum antibiotics with associated side effects
e.g. Clostridum difficile associated colitis
The correct answer is: Most members of the public have only a sketchy knowledge of the value
and use of antibiotics. For example, many patients expect an antibiotic when they get a cold
even though it is viral in origin and self limiting. Patients often don't understand the possibilities of
resistance emerging, if not amongst bacteria that they carry, then in the general community.
Unlike most other drugs, the prescription of an antibiotic has implications not only for the
individual patient, e.g. adverse reaction, but also in the wider community as the emergence and
spread of resistance affects us all.
We can prevent patients from getting infections in the first place, such as through the use
of vaccination in the community or through best practice in hospital, e.g. appropriate
hand hygiene.
We can also minimise the use or shorten the duration of use of invasive devices, e.g.
urinary catheters and intravascular lines which predispose a patient to infection.
We can diagnose infection effectively and promptly. This involves providing ready access
to diagnostic laboratories as well as radiology, and ensuring that the necessary expertise
is there to provide pre-analytical and post-analytical advice.
We can try to ensure that infections are treated wisely. Where an unusual or complicated
infection arises, advice should be sought from an appropriate expert, e.g. microbiologist
or infectious disease physician. Many hospitals now have an antibiotic pharmacist who
can also assist in ensuring patients are on appropriate antimicrobial treatment.
We can also use local or national surveillance data to ensure that empirical ("blind")
therapy is most likely to be effective, based upon data on antibiotic susceptibility from
laboratories
We can ensure prescribers have access to updated and accurate antibiotic guidelines for
the treatment of infections both in the community and in hospital
We can prevent transmission on infection through basic standards of hygiene, e.g. hand
hygiene, aseptic technique, good standards of personal hygiene, which will minimise the
occurrence of infection in both the hospital and in the community.