CHALLENGES AND SOLUTIONS TOWARDS ANTIMICROBIAL STEWARDSHIP IMPLEMENTATION

Abstract

The silent pandemic of antimicrobial resistance has led to significant emphasis towards antimicrobial stewardship (AMS). AMS entails a coherent set of actions which promote using the antimicrobials responsibly. It focuses on all the efforts to promote judicious antibiotics prescription by the clinicians and meticulous compliance by the patients.Varied efforts towards AMS implementation have been observed over the time. The infectious disease consultants, pharmacists, microbiologists, policy makers all have been engaged at various levels to implement the AMS programs. In the healthcare setting, various sections and relevant infectious diseases have been targeted based on the evidence on increased/injudicious use of antimicrobials. Frequently, pediatrics, surgical departments, emergency sections were mainly targeted; and infections like upper respiratory infection, urinary tract infections, and wound infections were monitored under the local AMS program.All the countries are struggling with the concept and implementation of AMS in a true sense. Key challenges in progress of AMS included poor practices of clinicians, static behavioral approaches, insufficient workforce at hospitals, poorly defined AMS metrics. Moreover, the LMICs suffer due to fragmented systems and poor response of authoritative bodies, and lack of coordination among different sectors.AMS challenges should be addressed by concerted and coherent approaches, aiming to implement AMS programs in an effective manner. The assistance through continuous education of medical, nursing staff, patients, and families can help to reinforce the AMS concept. There should be development of empirical treatment guidelines to support early rationalization or de-escalation at healthcare settings. Role of microbiologists and infection prevention and control teams is imperative in this regard. There should be continuous discouragement towards antibiotic prescribing without clinical examination and microbiology laboratory results. Diagnostic stewardship, telehealth in resource poor settings, constant encouragement and engagement of bedside nurses may help to successful AMS implementations.