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Toolbox  –  Rational use

Health care

Rational use initiatives work to prevent harm, improve patient safety and work to reverse increasing rates of antibiotic resistance.

Antibiotic stewardship programs

Up to 50% of the use of antibiotics is inappropriate, adding considerable costs to patient care and increasing both morbidity and mortality. Rational use or antibiotic stewardship programs are coordinated interprofessional efforts to improve and measure the appropriate use of antibiotics in order to optimize clinical outcomes, minimize unintended consequences such as toxicity, and reduce the selection pressure on bacterial populations that lead to the emergence of resistance. They can focus on for example antibiotic selection, dosing, route, and duration of therapy, which are primarily decisions undertaken by prescribers.

Rational use initiatives have demonstrated that it is possible to improve use of antibiotics, patient care, provide cost savings and in some cases reduce resistance levels.

Get started

Many initiatives can be taken within individual health care facilities to improve the use of antibiotics. However, a formally organized stewardship program has greater chances for a longer lasting effect. National guidelines, when they exist, can form the basis for and facilitate the development and implementation of programs at health care-facilities.

  • Core components outlines basic, overarching elements recommended to include in a rational use program or effort.
  • Set up a program describes the use of a five-step project management process to establish rational use programs in health care facilities.
  • Interventions provides information and resources on possible interventions for the rational use of antibiotics.
  • Coordination with infection prevention efforts are also of great importance.
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Centers for Disease Control and Prevention (U.S.). Antibiotic resistance threats in the United States, 2019. https://stacks.cdc.gov/view/cdc/82532 (2019) doi:10.15620/cdc:82532.
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World Health Organization - WHO. The evolving threat of antimicrobial resistance: options for action. (World Health Organization, 2012).
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Society for Healthcare Epidemiology of America, Infectious Diseases Society of America & Pediatric Infectious Diseases Society. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol 33, 322–327 (2012).
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Moody, J. et al. Antimicrobial stewardship: a collaborative partnership between infection preventionists and health care epidemiologists. Am J Infect Control 40, 94–95 (2012).
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Dellit, T. H. et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin. Infect. Dis. 44, 159–177 (2007).