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Rational use

The RATIONAL USE focus area of the Toolbox describes the practical steps to begin or strengthen work to improve rational use of antibiotics in different settings.

What does the RATIONAL USE focus area cover?

  • Health care gives guidance on the process of setting up stewardship programs at health care facilities, core components for promoting rational use and possible interventions.
  • Food animals provides an overview of what can be done to improve antibiotic use in food animal production.
  • Inspirational examples highlights some initiatives aiming to improve the rational use of antibiotics.

The narrative text is accompanied by shorter case examples and “Selected resources” – hands-on materials and tools that may be used directly or adapted to your particular setting. Browse through then pick and choose what material is most helpful for you!

Why rational use?

All antibiotic use, whether appropriate or not, can promote the development of resistance in pathogenic and commensal bacteria. The goal of rational use is not always to reduce antibiotic use, but to ensure that the use is appropriate. Antibiotics are a precious but finite resource and the benefit of their use must be weighed against the risks for society and the patient.

Importantly, rational use is also a matter of making sure people have access to effective antibiotics, in a sustainable way. Access should not be seen as being at odds with rational use. Both are essential to ensure patient safety, quality of care and health equity.

In human medicine

Unlike other medicines, antibiotics target not the actual patient, but instead the growth and ecology of invading pathogens and commensal microorganisms. As resistant bacteria spread from one host to the next, the greatest burden of inappropriate use in many cases falls on public health instead of the consumer of the drug, complicating strategies to improve use. That said, rational use of antibiotics must also be considered an issue of patient safety, as antibiotic use can have direct negative side effects on the individual consumer, including allergic reactions, Clostridium difficile infection and antibiotic associated diarrhea/colitis. Learn more in UNDERSTAND: Why should I care?

The food animal sector

In the animal and agricultural sectors, antibiotics are also widely used to treat disease, to prevent disease and for non-therapeutic reasons such as to promote growth of animals. The antibiotic use is often inappropriate due to lack of proper guidelines, diagnosis or information on correct treatments.

A threat to human and animal health

Antibiotic resistant bacteria are frequently identified in studies and surveillance programs within the farm animal sector. These bacteria have the potential to spread to humans, by direct contact and indirectly via the food chain, water, air and manured and sludge-fertilized soils. The exact magnitude of transmission is not known, but there is an ever expanding volume of evidence reporting transmission of resistant bacteria between food animals and humans. A high antibiotic pressure is also a risk factor in the emergence and spread of new multidrug-resistant bacteria. Read more in UNDERSTAND – Antibiotics in the environment.

On top of the impact on human health, antibiotic resistance in animal pathogens can lead to therapy failure with a negative effect on animal health and welfare. There is also an increasing understanding within the veterinary sector that any upcoming new antibiotic will likely be preserved for human medicine only.

Multifaceted and coordinated approaches needed

Multifaceted, coordinated approaches to promote rational use are urgently needed as the prudent use of antibiotics is crucial to preserving existing antibiotics and improving patient outcomes. Initiatives can be done in a variety of settings and can range in size from a simple intervention to a full scale rational use program.

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