Hospital antibiotic stewardship to control resistance-how should it be done?

Abstract

Antibiotic stewardship was originally developed as a cost saving initiative. Increasingly it is looked to as a mechanism of slowing the tide of resistance. There is an accumulating body of robust publications which show it is possible to reduce resistance rates across a wide spectrum of organisms by reducing broad spectrum antibiotic use, in particular cephalosporins and quinolones. The resistant organisms that can be so controlled include MRSA, Clostridium difficile and multi resistant Gram-negatives. Implementation of a successful stewardship programme depends upon a local understanding of problem areas in prescribing and a multi disciplinary, long term educational commitment. Restrictive practices can also be very effective, perhaps particularly in the short term. Local initiatives need complimentary action on an infection control front and no hospital can consider itself isolated from the surrounding community nor, increasingly from the whole world.