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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.

Twelve core components to promote the rational use of medicines

The WHO has outlined select core components to promote the rational use of medicines at the healthcare facility and national level

  1. A mandated multi-disciplinary national body to coordinate medicine use policies
  2. Clinical guidelines
  3. Essential medicines list based on treatments of choice
  4. Drugs and therapeutics committees in districts and hospitals
  5. Problem-based pharmacotherapy training in undergraduate curricula
  6. Continuing in-service medical education as a licensure requirement
  7. Supervision, audit and feedback
  8. Independent information on medicines
  9. Public education about medicines
  10. Avoidance of perverse financial incentives
  11. Appropriate and enforced regulation
  12. Sufficient government expenditure to ensure availability of medicines and staff

Core components specific for rational antibiotic use efforts in different health care settings have been outlined by for example the Centers for Disease Control and Prevention (CDC, USA). These highlight, among other things:

  • Leadership Commitment
  • Accountability
  • Action (implementation of at least one policy or practice)
  • Tracking and reporting
  • Education (of antibiotic prescribers/providers, and patients)

Find additional information on core components in the resource table below. How to initiate or strengthen work to implement the core components of rational use in health care in a structured way is covered in Set up a program. Possible strategies/actions to include in such efforts can be found in Interventions.

Selected Resources

Resource Description
Promoting Rational Use of Medicines: Core Components 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.
Core Elements of Hospital Antibiotic Stewardship Programs Core elements 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. Global
The Core Elements of Antibiotic Stewardship for Nursing Homes 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).


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