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
- A mandated multi-disciplinary national body to coordinate medicine use policies
- Clinical guidelines
- Essential medicines list based on treatments of choice
- Drugs and therapeutics committees in districts and hospitals
- Problem-based pharmacotherapy training in undergraduate curricula
- Continuing in-service medical education as a licensure requirement
- Supervision, audit and feedback
- Independent information on medicines
- Public education about medicines
- Avoidance of perverse financial incentives
- Appropriate and enforced regulation
- 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
- Action (implementation of at least one policy or practice)
- Tracking and reporting
- Education (of antibiotic prescribers/providers, and patients)
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.
|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. 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).|