G𝐮𝐚𝐫𝐝𝐢𝐚𝐧𝐬 𝐎𝐟 𝐎𝐮𝐫 𝐇𝐞𝐚𝐥𝐭𝐡: 𝐄𝐦𝐛𝐫𝐚𝐜𝐢𝐧𝐠 𝐀𝐧𝐭𝐢𝐦𝐢𝐜𝐫𝐨𝐛𝐢𝐚𝐥 𝐒𝐭𝐞𝐰𝐚𝐫𝐝𝐬𝐡𝐢𝐩

Antimicrobial resistance is a rising global issue that impacts the efficacy of antibiotics and other antimicrobial treatments. Healthcare experts, veterinarians, farmers, and the general public must all work together to address this problem. Antimicrobial stewardship is a collaborative endeavour that upholds the ideals of One Health, which acknowledges the interdependence of human, animal, and environmental health. In this article, we’ll go into the world of antimicrobial stewardship and explore its significance, key practises, and role in preserving human health.
By encouraging the choice of the best antimicrobial drug regimen, dose, course of treatment, and method of administration, antimicrobial stewardship refers to coordinated initiatives intended to enhance and gauge the proper use of antibiotics. Further it seeks to achieve optimal clinical outcomes related to antimicrobial use, minimize toxicity and other adverse events, reduce the costs of health care for infections, and limit the selection of antimicrobial-resistant strains. antimicrobial stewardship is about using antimicrobials responsibly, which involves promoting actions that balance both the individual’s need for appropriate treatment and the longer-term societal need for sustained access to effective therapy.

Antibiotic resistance is a global crisis. Not only the human population but also food and food animals are equally contributing to antibiotic resistance. Animals also carry bacteria in their gut which might also include antibiotic-resistant bacteria. People can get infections from handling or eating meat or food contaminated with resistant bacteria, from contact with animal waste, and from touching animals without proper handwashing. Antimicrobial stewardship refers to the multifaceted approach (including policies, guidelines, surveillance, prevalence reports, education, and audit of practice) that healthcare organizations have adopted to optimize prescribing.
A comprehensive approach to stop the development of antibiotic resistance must include antimicrobial stewardship as a significant element. Antimicrobial stewardship is a suggested approach to the interrelated issues of rising antibiotic resistance, declining antimicrobial agent availability, and suboptimal use of antibiotics in clinical practice: A critical mission of preservation of antimicrobial utility.

Antibiotic use must be closely monitored due to an increase in multi-drug resistant organisms and a decline in the development of anti-infective agents. An Antimicrobial stewardship program (ASP) is essential in any hospital or healthcare facility to decrease antimicrobial resistance incidence and improve patient care. The ASP is a collaborative effort that involves multiple specialties and departments. A successful ASP changes based on local prescribing trends and resistance patterns while focusing on a patient as an individual.

The ASP programs have the following goals:

To work with healthcare practitioners to prescribe the 5 “D”s of antimicrobial therapy, which are the right Drug, correct Dose, right Drug-route, suitable Duration, and timely De-escalation to pathogen-directed therapy.

To prevent antimicrobial overuse, misuse, and abuse in inpatient, outpatient, and community settings, including the agriculture industry.

To reduce antibiotic-related adverse effects, for example, C.difficile

To minimize resistance

The AMS programs include the following core elements:

Leadership commitment: To dedicate necessary human, financial, and information technology resources, having dedicated time and resources to operate the program effectively.

Accountability: It is necessary to appoint a leader or co-leaders responsible for the results of ASPs activities among clinicians or pharmacists so that someone could take responsibility for managing the program and monitoring its results.

Drug expertise: The participation of pharmacists is critical for leading the efforts to improve antibiotic use. Appoint a pharmacist, ideally as the co-leader of the stewardship program, to lead implementation efforts to improve antibiotic use.

Action Implement: Interventions, such as prospective audit and feedback or pre-authorization, is essential to improve antibiotic use. In addition, staff-pharmacy interventions, drug level monitoring, automatic warning for unnecessary repetition of antibiotic prescription, notification for antibiotic use for more than a reasonable period, detection of interactions between antibiotic-related drugs, and other drugs, and infection- and syndrome-specific interventions could be focused on diagnostic assessment. Microbial testing and antimicrobial susceptibility test are important for the selection of the appropriate empiric antibiotics. A new category of nursing-based actions was added to reflect the important role that nurses can play in hospital antibiotic stewardship efforts.

Tracking: This involves monitoring antibiotic prescribing, the impact of interventions, and resistance patterns. It is also important to collect and analyze the data on the antibiotics used in each medical facility at the government level.

Reporting: Regularly reporting information on antibiotic use and resistance to prescribers, pharmacists, nurses, and hospital leadership. Information about the incidence of antibiotic-resistant bacterial infections is prepared by collaborating with the hospital’s microbiology lab and infection control and healthcare epidemiology department.

Education: Educating prescribers, pharmacists, patients, and nurses about adverse reactions from antibiotics, antibiotic resistance, and optimal prescribing is a core element of ASP.

AMS is one of three “pillars” of an integrated approach to health systems strengthening. The other two are infection prevention and control (IPC) and medicine and patient safety. When applied in conjunction with antimicrobial use surveillance, and the WHO essential medicines list (EML) AWaRe classification (ACCESS, WATCH, RESERVE), AMS helps to control Antimicrobial resistance by optimizing the use of antimicrobials. Linking all three pillars to other key components of infection management and health systems strengthening, such as AMR surveillance and adequate supply of quality assured medicines, promotes equitable and quality health care towards the goal of achieving universal health coverage.