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The Infectious Diseases Society of America (IDSA) defines antimicrobial
stewardship as the "coordinated interventions designed to improve and measure
the appropriate use of antimicrobials by promoting the selection of the optimal
antimicrobial drug regimen, dose, duration of therapy, and route of
administration."1 These efforts seek to improve clinical outcomes,
reduce health care costs, and slow bacterial resistance rates.
The following tips can help to promote antimicrobial stewardship:
- Consider practicing "watchful waiting" for upper respiratory infections in
children and acute bronchitis in adults. Examples include:
- – The 3-Day Rule: Follow up with patients three days after the
initial visit to discuss treatment options if symptom relief has not
occurred.
- – The Poster Board Pledge: Display a poster-sized commitment
letter in exam rooms to avoid inappropriate antibiotic prescribing. Recent
studies show this as a simple, low-cost, and effective method for
improvement.2
- Order group A streptococcus tests in children with pharyngitis prior to
ordering antibiotics as "only about 30 percent of all cases of pharyngitis in
children are caused by bacteria. Be sure to follow the pediatric guidelines for
appropriate treatment."3
- Minimize the use of broad-spectrum antibiotics when narrow-spectrum
antibiotics are indicated and recommended.
To learn more about the IDSA's efforts to promote antimicrobial stewardship in
human medicine, visit their
website.
1http://www.idsociety.org/Stewardship_Policy/ and
http://www.who.int/mediacentre/factsheets/antibiotic-resistance/
en/
2Meeker D, et al. ?Nudging guideline-concordant antibiotic
prescribing: A randomized clinical trial,? JAMA Intern Med.
2014;174(3):425-31.
3National Committee for Quality Assurance (NCQA).The State
of Health Care Quality 2014. Washington (DC): National Committee for Quality
Assurance (NCQA); Final Edition 2014; p. 70.
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