title: Antimicrobial stewardship programs: how to start and steer a successful program.
abstract: BACKGROUND
  Antimicrobial stewardship programs (ASPs) promote the appropriate use of antimicrobials by selecting the appropriate dose, duration, and route of administration. The appropriate use of antimicrobials has the potential to improve efficacy, reduce treatment-related costs, minimize drug-related adverse events, and limit the potential for emergence of antimicrobial resistance.
  
  
  OBJECTIVE
  To summarize ASP tactics that can improve the appropriate use of antimicrobials in the hospital setting. Several measures can be used to implement such programs and gain multidisciplinary support while addressing common barriers.
  
  
  CONCLUSIONS
  Implementation of an ASP requires a multidisciplinary approach with an infectious diseases physician and a clinical pharmacist with infectious diseases training as its core team members. As identified by recently published guidelines, 2 proactive strategies for promoting antimicrobial stewardship include: (1) formulary restriction and pre-authorization, and (2) prospective audit with intervention and feedback. Other supplemental strategies involve education, guidelines and clinical pathways, antimicrobial order forms, de-escalation of therapy, intravenous-to-oral (IV-to-PO) switch therapy, and dose optimization. Several barriers exist to successful implementation of ASPs. These include obtaining adequate administrative support and compensation for team members. Gaining physician acceptance can also be challenging if there is a perceived loss of autonomy in clinical decision making.
  
  
  CONCLUSIONS
  ASPs have the potential to reduce antimicrobial resistance, health care costs, and drug-related adverse events while improving clinical outcomes. The efforts and expense required to implement and maintain ASPs are more than justified given their potential benefits to both the hospital and the patient.
authors.affiliation: Campbell University School of Pharmacy, Duke Medical Center, Durham, NC 27710, USA. richard.drew@duke.edu
authors.forename: Richard H
authors.initials: RH
authors.lastname: Drew
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D004333:Drug Administration Routes; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000592:standards; D005572:Formularies, Hospital as Topic; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000592:standards; D016357:Infection Control Practitioners; D010595:Pharmacists; D017410:Practice Guidelines as Topic; D015397:Program Evaluation
chemical_list: D000900:Anti-Bacterial Agents