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 is afflicted by, and in the case of infectious diseases what is causing the disease. It is the clinical assessment of symptoms and results from diagnostic tests made by the healthcare provider. This information is then 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, i.e. a well-educated health workers and access to relevant diagnostic tests.
Learn more about diagnostics in these ReAct articles:
Core components from different organizations and research groups are collected below.
|Antimicrobial stewardship programmes in health-care facilities in low- and middle-income countries: A WHO practical toolkit||Report from WHO. Contains recommendations and how-to guidance for setting up and implementing antimicrobial stewardship. Specifies core elements for antimicrobial stewardship programmes on both national and facility level. Available in English, Arabic, Russian, French and Spanish. Low- and middle-income countries.|
|Promoting Rational Use of Medicines: Core Components||Framework. Core components to promote the rational use of medicines at the healthcare facility and national level. WHO document, available in English, French and Spanish. Global|
|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). Resource-limited settings.|
|Global core standards for hospital antimicrobial stewardship programs, international perspectives and future directions||Report from Leading Health Systems Network and CDDEP suggesting standards for rational use programs in hospitals. Includes checklists (also available in Spanish, Portuguese and Chinese) for hospital programs and identifies barriers to implementation with possible measures to overcome them. While overlapping with core components proposed by CDC and others, the checklists are designed to be applicable also in low-resource settings.|
|Core Elements of Hospital Antibiotic Stewardship Programs||Framework and checklist. 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). See also companioning checklist.|
|Core Elements of Outpatient Antibiotic Stewardship||Framework for antibiotic stewardship in outpatient clinics and health-care facilities by the US CDC.|
|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. (Paywall) Global|
|The Core Elements of Antibiotic Stewardship for Nursing Homes||Framework. Core elements for long-term care. Transfers the Core Elements of Hospital Antibiotic Stewardship from the US CDC into the setting of nursing homes (long-term care facilities).|