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Rational use  –  Health care

Core components

Find here core components for work to promote rational use (stewardship) of antibiotics in different health care settings.

Rational use activities should take place at all levels of care (hospital, community/primary/outpatient care, and long-term care). Depending on the setting, different components may be relevant.

Core components specific for rational antibiotic use efforts in health care settings in low- and middle-income countries have been outlined by the WHO. These are stratified on resource requirement and are categorized into:

  • Leadership commitment (for example dedicated financial support)
  • Accountability and responsibility (for example clearly defined collaboration between the antimicrobial stewardship (AMS) and infection prevention and control (IPC) programmes, and having a multidisciplinary AMS leadership committee in place)
  • AMS actions (for example up-to-date standard treatment guidelines, regular AMS team review/audit of specified antibiotic therapy etc)
  • Education and training
  • Monitoring and surveillance (for example of appropriateness of antibiotic use, resistance rates of key bacteria etc)
  • Reporting and feedback


Diagnostics are used to determine what disease a patient has, and in the case of infectious diseases what is causing the disease. A patient diagnosis is based on the clinical assessment of symptoms made by the healthcare provider, and the results from diagnostic tests. This information is used to determine what the appropriate therapy is. For example a specific antibiotic, other medicines or bed rest. Rational use programs are dependent on good diagnostics, that is, a well-educated health worker and access to relevant diagnostic tests.

Core components from different organizations and research groups are collected below.

How to initiate or strengthen work to implement the core components is covered in Set up a program. Possible strategies and actions to include can be found in Interventions.

Selected Resources

Resource Description
Antimicrobial stewardship programmes in health-care facilities in low- and middle-income countries: A WHO practical toolkit Manual with recommendations and guidance for setting up and implementing antimicrobial stewardship programs. Specifies core elements on both national and facility level. Available in English, Arabic, Russian, French and Spanish.
Core Elements of Human Antibiotic Stewardship Programs in Resource-Limited Settings: National and Hospital Levels Framework for implementation of antibiotic stewardship programs in resource-limited settings from the US CDC. It takes a tiered approach and covers a range of activities that a government or individual facility can implement based on the resources available. (PDF, 3MB).
Developing core elements and checklist items for global hospital antimicrobial stewardship programmes: a consensus approach Journal article that suggests global core elements of antibiotic stewardship programs, including checklist items, to be in place in all hospitals. Aims to facilitate the development of national guidelines as well as adoption by healthcare facilities across the world, regardless of resource availability.
Core Elements of Hospital Antibiotic Stewardship Programs Framework. Lists and describes core elements of stewardship programs in hospitals, such as leadership, accountability, drug expertise, action, tracking, reporting and education. Developed by the CDC (USA). The core elements have also been adapted for Outpatient Antibiotic Stewardship as well as for Nursing homes.
Behavior-change interventions to improve antimicrobial stewardship in human health, animal health, and livestock agriculture: A systematic review Article. A systematic review of studies that describe behavior-change interventions aimed at improving antimicrobial stewardship and/or reducing inappropriate antimicrobial use in human and animal health, as well as in livestock agriculture.

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