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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 and 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. While initial financial support is crucial for developing initiatives, programs can become self supporting over time.

Get started

Many initiatives can be taken within individual health care facilities to improve the use of antibiotics. However, a formally organized rational use 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 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.
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World Health Organization - WHO. The evolving threat of antimicrobial resistance: options for action [Internet]. Geneva, Switzerland: World Health Organization; 2012 [cited 2018 Aug 13]. 119 p. Available from: http://apps.who.int/iris/handle/10665/44812
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Centers for Disease Control and Prevention - CDC. Core Elements of Hospital Antibiotic Stewardship Programs [Internet]. National Center for Emerging and Zoonotic Infectious Diseases; 2014 [cited 2014 Aug 20]. Available from: http://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html
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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 [Internet]. 2012 Apr;33(4):322–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22418625
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Moody J, Cosgrove SE, Olmsted R, Septimus E, Aureden K, Oriola S, et al. Antimicrobial stewardship: a collaborative partnership between infection preventionists and health care epidemiologists. Am J Infect Control [Internet]. 2012 Mar;40(2):94–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22381221
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Dellit TH, Owens RC, McGowan JE, Gerding DN, Weinstein RA, Burke JP, 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 [Internet]. 2007 Jan 15;44(2):159–77. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17173212
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Centers for Disease Control and Prevention - CDC. Antibiotic Stewardship - the ultimate return on investment [Internet]. Centers for Disease Control and Prevention; 2013 [cited 2014 Aug 20]. Available from: http://www.cdc.gov/getsmart/campaign-materials/week/downloads/gsw-factsheet-cost.pdf
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Centers for Disease Control and Prevention - CDC. Antibiotic Resistance Threats, 2013 [Internet]. Centers for Disease Control and Prevention; 2013 [cited 2014 Oct 1]. Available from: http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf