Find here practical tools and examples of interventions and initiatives for appropriate antibiotic use in hospitals and primary healthcare settings.
When designing interventions, the closer they are aimed at the provider/prescriber of antibiotics, as opposed to facility or national level, the more effective they have shown to be. It is also important to keep in mind how implementation of one intervention may affect the situation elsewhere. Restricting use of a specific antibiotic or targeting of a specific bacterial pathogen may lead to increased use of other antibiotics or have unintended effects on other bacteria. Each health care facility needs to do their own assessment to understand what is needed and appropriate for their setting, and how to evaluate the work. The section Set up a program provides guidance on how to implement interventions in a structured way.
Want to keep up to date and learn about relevant rational use initiatives?
The Center for Infectious Disease Research and Policy (CIDRAP) has a monthly newsletter on antimicrobial stewardship here.
Persuasive interventions
Persuasive interventions are those that use one or more of the following methods for changing professional behavior: dissemination of educational resources, reminders, audit and feedback, or educational outreach.
Continual education of health care professionals can be a means to keep staff up to date, make them aware of policies, familiar with changes in pharmacotherapy, and allow them to share experiences and learn from discussion with peers. Ideally, passive education should be combined with active interventions; as a standalone initiative passive education has shown to provide only marginal results.
Educational intervention makes an impact on antibiotic prescription patterns at a hospital:
During an outbreak of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae at a hospital in Sweden, an educational antibiotic intervention was performed aimed at reducing prescriptions of second- and third-generation cephalosporins and preventing increased use of fluoroquinolones and carbapenems.
New recommendations for empirical intravenous antibiotic treatment were communicated to prescribers throughout the hospital by infectious diseases physicians working with the Swedish strategic programme against antibiotic resistance. No restrictive measures were used. A radical immediate and sustained reduction was demonstrated for the cephalosporins targeted in the intervention. Fluoroquinolone and carbapenem use was essentially unchanged. The ESBL outbreak subsided and no increased resistance to the replacement drug was detected during the 2.5 year follow-up. This study clearly demonstrates that an educational intervention can have an immediate and profound effect on antibiotic prescription patterns at a large tertiary hospital.
Restrictive interventions
Restrictive interventions are initiatives that limit the freedom of prescribers/providers to select certain antibiotics. For example, prescriptions of the targeted antibiotics might require approval by an infectious diseases specialist, might be substituted by a pharmacist or completely restricted during the intervention period.
Multifaceted interventions
Multifaceted interventions are those that use a combination of approaches to influence the rational use of antibiotics. Persuasive and restrictive antibiotic interventions might be performed in parallel with structural changes or other approaches to improve prescribing practices. This might result a more profound immediate and sustained effect of the intervention than would have been achieved with any of the components alone.
See MEASURE to access tools and resources to assist in assessing the situation and evaluating the effect of interventions. It includes a variety of topics that relates to rational use:
- Burden of antibiotic resistance
- Antibiotic resistance
- Consumption of antibiotics
- Appropriateness of use
- Infections
- Quality of antibiotics
- Knowledge, attitudes, beliefs and practices – KABP
Resources below have been divided into the following tables:
- General resources
- Hospital (inpatient)-specific resources
Additionally, educational resources (such as courses and training manuals) are collected in RAISE AWARENESS: Education and training. Further help to start or strengthen awareness raising initiatives can be found in RAISE AWARENESS: Set up a campaign.
Selected Resources
General resources
| Resource | Description |
|---|---|
| Antimicrobial stewardship programmes in health-care facilities in low- and middle-income countries: a WHO practical toolkit | Guideline by WHO, provides a stepwise approach to plan, implement, and assess antimicrobial stewardship programs in low-resource settings at national and facility levels. Section 5 contains a selection of possible interventions/ activities. |
| Antimicrobial Stewardship and Infection Prevention and Control in Low- and Middle-income Countries | Article series that reviews the current evidence and best practices on antibiotic stewardship and IPC measures in LMICs, with specific focus on children. It also includes the experiences and lessons learned by clinicians working on rational use initiatives. |
| Antibiogo | Mobile app for measurement and interpretation of antibiotic susceptibility tests. Developed by Doctors Without Borders. Described and evaluated in an article published in Nature communications. |
| TARGET antibiotic toolkit | Intervention materials for optimizing antibiotic prescribing in primary care, includes audit toolkits and leaflets for patients. Developed in the British context. |
| Help Prescribing Clinicians Choose the Right Antibiotic | Toolkits for establishing the use of an antibiogram in nursing homes, developed by the Agency for Healthcare Research and Quality:
|
| Behavior-change interventions to improve antimicrobial stewardship in human health, animal health, and livestock agriculture: A systematic review | 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. |
Hospital (inpatient)-specific resources
| Resource | Description |
| Interventions to improve antibiotic prescribing practices for hospital inpatients | Systematic review of the effectiveness of interventions that alone, or in combination, are promoting prudent antibiotic prescribing to hospital inpatients (Cochrane). |
| Global Point Prevalence Survey on Antimicrobial Consumption and Resistance | PPS protocols and methodology – Ongoing project that welcomes new participants from across the world. This open to join project monitors antimicrobial prescribing and resistance in hospital patients on all continents through a “one day survey” and helps design hospital interventions to promote prudent use. Hospitals are welcome to join survey and network (already more than 300 institutions from over 50 countries have participated). For documents such as protocols, data collection templates and presentations in different languages for personal use click here. Numerous scientific publications with results from the project have been published. Available in several languages. |
| Antibiotic rounds as a tool for antimicrobial stewardship | Online course for healthcare professionals that provides an introduction to antibiotic rounds as a stewardship strategy in hospital settings. It describes the tools required for implementation and major challenges that may be encountered. |
More from "Health care"
- Core components
- Set up a program
- Interventions