title: The role of antimicrobial management programs in optimizing antibiotic prescribing within hospitals.
abstract: Managing serious infections is a balance between providing timely and appropriate broad-spectrum empirical therapy for individual patients, which has been consistently shown to improve outcomes, and reducing unnecessary use of antimicrobial agents, which may contribute to the development of antimicrobial resistance. To control the spread of antimicrobial resistance, hospitals commonly implement programs designed to optimize antimicrobial use, supported by infection-control measures. Hospital-based antimicrobial management programs--also called "antimicrobial stewardship programs"--are primarily based on education coupled with a "front-end" approach (i.e., restricting the availability of selected antimicrobial agents) or a "back-end" approach (i.e., reviewing broad-spectrum empirical therapy and then streamlining or discontinuing therapy, as indicated, on the basis of culture and susceptibility testing results and clinical response). Institutional efforts to optimize antimicrobial use should concentrate on patient outcomes, should have multidisciplinary support, and should use a combination of interventions customized to the needs, resources, and information technology infrastructure of the health care institution.
authors.affiliation: Antibiotic Management Program and Transplant Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. PatersonD@dom.pitt.edu
authors.forename: David L
authors.initials: DL
authors.lastname: Paterson
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control; D011307:Drug Prescriptions / Q000592:standards; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000592:standards*; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000592:standards
chemical_list: D000900:Anti-Bacterial Agents