title: Antibiotic stewardship programmes--what's missing?
abstract: Inappropriate antibiotic use and antibiotic resistance are now major global issues. Antimicrobial stewardship programmes are increasingly being used to optimize antibiotic prescribing in acute care. The central tenet of these programmes tends to be policy and guidelines aimed at prescribers. However, rules and guidelines alone may not be sufficient to bring about effective and sustainable optimization of practice. Best practice needs to be positively reinforced by an environment that facilitates and supports optimal prescribing choices, i.e. a 'choice architecture' that makes prudent antibiotic prescribing the path of least resistance. To make prudent antibiotic management an integral part of the behaviour of all healthcare professionals and to bring about quality improvement it is necessary to adopt a whole-system approach. To do this it is necessary first to understand the factors that influence antibiotic management and prescribing.
authors.affiliation: Centre for Infection Prevention and Management, Imperial College, London W12 OHS, UK. e.charani@imperial.ac.uk
authors.forename: Esmita
authors.initials: E
authors.lastname: Charani
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cooke
authors.forename: Alison
authors.initials: A
authors.lastname: Holmes
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000517:prevention & control*; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000592:standards*; D006291:Health Policy; D006801:Humans; D016134:Organizational Policy; D055656:Prescriptions / Q000592:standards
chemical_list: D000900:Anti-Bacterial Agents