title: Antimicrobial stewardship programs in health care systems.
abstract: Antimicrobial stewardship programs in hospitals seek to optimize antimicrobial prescribing in order to improve individual patient care as well as reduce hospital costs and slow the spread of antimicrobial resistance. With antimicrobial resistance on the rise worldwide and few new agents in development, antimicrobial stewardship programs are more important than ever in ensuring the continued efficacy of available antimicrobials. The design of antimicrobial management programs should be based on the best current understanding of the relationship between antimicrobial use and resistance. Such programs should be administered by multidisciplinary teams composed of infectious diseases physicians, clinical pharmacists, clinical microbiologists, and infection control practitioners and should be actively supported by hospital administrators. Strategies for changing antimicrobial prescribing behavior include education of prescribers regarding proper antimicrobial usage, creation of an antimicrobial formulary with restricted prescribing of targeted agents, and review of antimicrobial prescribing with feedback to prescribers. Clinical computer systems can aid in the implementation of each of these strategies, especially as expert systems able to provide patient-specific data and suggestions at the point of care. Antibiotic rotation strategies control the prescribing process by scheduled changes of antimicrobial classes used for empirical therapy. When instituting an antimicrobial stewardship program, a hospital should tailor its choice of strategies to its needs and available resources.
authors.affiliation: Department of Pharmacy, School of Pharmacy, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, Virginia 23298, USA. macdougallc@pharmacy.uscf.edu
authors.forename: Conan
authors.initials: C
authors.lastname: MacDougall
authors.forename: Ron E
authors.initials: RE
authors.lastname: Polk
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology; D020000:Decision Support Systems, Clinical; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000592:standards; D006801:Humans; D017053:Infection Control / Q000592:standards*; D008490:Medical Informatics; D017063:Outcome Assessment, Health Care / Q000592:standards; D010605:Pharmacy Administration; D016730:Program Development; D009626:Terminology as Topic
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents