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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.

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.

Up to 50% of the use of antibiotics is inappropriate, adding considerable costs to patient care and increasing both morbidity and mortality. Initiatives to improve the use of antibiotics have demonstrated that it is possible to improve use, patient care, provide cost savings and in some cases reduce resistance levels. While initial financial support is crucial for developing initiatives, programs can become self supporting over time.

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Many individual initiatives can be taken to improve the rational use of antibiotics, however a formally organized rational use program has greater chances for a longer lasting effect. Where programs do not exist, they should be established, where they do, they should be constantly improved upon. National guidelines can form the basis for and facilitate the development and implementation of programs at health care-facilities. However, it is also possible for initiatives to begin within a health care facility and lead to the development of national guidelines.

Programs should be based on the core components of rational use of medicines recommended by the WHO and may include restrictive, persuasive or multifacted interventions.

Core components outlines basic, overarching elements recommended to include in an 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.

Selected Resources

Resource Description
Antibiotic stewardship – the ultimate return on investment Factsheet about the benefits of antibiotic stewardship programs, part of the CDC Get Smart about Antibiotics Week 2014.