Antimicrobial Stewardship

The problem of antimicrobial-resistant organisms and untreatable infections is of global concern. The concept of antimicrobial stewardship has been developing over the last 10 years. The aim of antimicrobial stewardship is to control antimicrobial use in order to reduce the development of resistance, avoid the side effects associated with antimicrobial use, and optimize clinical outcomes. This book provides a very practical approach to antimicrobial stewardship. It’s very much a ‘how to’ guide supported by a review of the available evidence. Section 1 sets the scene and covers the problem of antimicrobial resistance; the problems in the antimicrobial supply line and initiatives to improve the situation; the principles and goals of antimicrobial stewardship; the psychological, social, cultural, and organizational factors in antimicrobial use and prescribing; and how to establish an antimicrobial stewardship programme. Section 2 reviews the components of antimicrobial stewardship: audit and feedback; antimicrobial policies and formularies; antimicrobial restriction; intravenous to oral switch; measuring antimicrobial consumption; measuring and feeding back stewardship; and the use of information technology in antimicrobial stewardship. Section 3 explores special areas in antimicrobial stewardship: antimicrobial pharmacokinetics and pharmacodynamics; intensive care units; paediatrics; surgical prophylaxis; near-patient testing and infection biomarkers; antimicrobial stewardship in the community and long-term care facilities; and finally antimicrobial stewardship in resource-poor communities.