Antimicrobial stewardship interventions: a practical guide

1 Antimicrobial stewardship interventions : a practical guideAntimicrobial stewardship interventions : a practical guide World Health Organization 2021 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike IGO licence (CC BY-NC-SA IGO; ). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services.

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3 Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. ( )Suggested citation. Antimicrobial stewardship interventions : a practical guide . Copenhagen: WHO Regional Office for Europe; 2021. Licence: CC BY-NC-SA IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at , rights and licensing. To purchase WHO publications, see To submit requests for commercial use and queries on rights and licensing, see Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder.

4 The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned.

5 Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. AbstractAntimicrobial resistance (AMR) is a global public health emergency. Antimicrobial stewardship programmes have been identified as one of the core strategies to tackle AMR.

6 How to select the most appropriate interventions for each setting however remains challenging. This practical guide describes 10 commonly used stewardship interventions , which promote the optimal use of antimicrobials at health care facilities. Administrators, health care leaders and front-line clinicians learn about the most common interventions , the evidence behind them, as well as important implementation considerations, particularly for low-resource 978-92-890-5626-7 This title was initially published under ISBN: 978-92-890-5498-0 Address requests about publications of the WHO Regional Office for Europe to.

7 Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen DenmarkAlternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office website ( ).Design and layout: Acknowledgmentsvi Acronymsvii Introductionx Where to start? 1 interventions prior to or at the time of prescription2 Clinician education8 Patient and public education16 Institution-specific guidelines for the management of common infections 20 Cumulative antibiograms26 Prior authorization of restricted antimicrobials32 De-labeling of spurious antibiotic allergies37 interventions after prescription38 Prospective audit and feedback44 Self-directed antibiotic reassessments by prescribing clinicians (antibiotic timeouts)

8 50 Antibiotic dose optimization54 Antibiotic duration58 BibliographyviAcknowledgments This guide was prepared by Marisa Holubar (WHO Collaborating Centre for Antimicrobial Resistance and stewardship , Stanford University School of Medicine), Elisabeth Robilotti (Memorial Sloan Kettering Cancer Center), and Stan Deresinski (WHO Collaborating Centre for Antimicrobial Resistance and stewardship , Stanford University School of Medicine), under the technical guidance of Saskia Nahrgang (WHO Regional Office for Europe).Input and review were provided by Ketevan Kandelaki (WHO Regional Office for Europe), Danilo Lo Fo Wong (WHO Regional Office for Europe), and Onur Karatuna (European Committee on Antimicrobial Susceptibility Testing (EUCAST) Development Laboratory).

9 This document was produced with the financial assistance of the European Union. The views expressed herein can in no way be taken to reflect the official opinion of the European AMR Antimicrobial resistanceAWaRe Access Watch Reserve [classification system]CLSI Clinical and Laboratory Standards InstituteCNS central nervous systemICU intensive care unitPCN penicillinWAAW World Antimicrobial Awareness WeekviiIntroduction Introduction: Antimicrobial resistance (AMR) is a global public health emergency. AMR is the ability of a microorganism to survive and resist exposure to Antimicrobial drugs, threatening the effectiveness of successful treatment of infection.

10 There are different types of antimicrobials, which work against different types of microorganisms, antibacterials or antibiotics against bacteria, antivirals against viruses, antifungals against fungi, etc. Antimicrobials are life-saving drugs and their discovery is among the most important scientific advances of the 20th century. There is, however, accumulating data demonstrating that Antimicrobial misuse is widespread in all health care settings. The misuse of antimicrobials in human health care is one of the key modifiable drivers of the emergence of AMR. Antimicrobial stewardship in this practical guide refers to coordinated interventions designed to promote the optimal use of antibiotic agents, including the decision to use them, drug choice, dosing, route, and duration of administration.