ANTIMICROBIAL

STEWARDSHIP

By,
Prathusha.U
CRI
Department Of Public Health Dentistry
Chettinad Dental College And Research Institute
 CONTENTS
 Introduction
 Core Elements Of Antibiotic Stewardship
 What Does Antimicrobial Stewardship Prevent?
 Clinical Practice Guidelines
 Dose Optimization
 Awareness About Antimicrobial Stewardship
 Conclusion
 References
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 INTRODUCTION
• Coordinated intervention is designed to improve and
measure the appropriate use of antimicrobial agents,
by promoting the selection of optimal antimicrobial
drug regimen including dosing, duration of therapy
and route of administration (SHEA, IDSA, PIDS –
April 2012).

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Benefit Of Antimicrobial
Stewardship Program
• Limit inappropriate use of antibiotics
• Lower the chance for antibiotic-resistant
bacteria to develop.
• Prevent Clostridium difficile diarrhea.
• Reduce Hospital costs and lengths of stay
• Reduce Adverse Effects
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Antimicrobial prescribing facts:
The 30% Rule
• 30% of all hospitalised in-patient at any given time
receive antibiotics
• Over 30% of antibiotics are prescribed inappropriately
in the community
• Up to 30% of all surgical prophylaxis is inappropriate
• 30% of hospital pharmacy costs are due to
antimicrobial use
• 10-30% of antimicrobial cost can be saved by
antimicrobial stewardship programs
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WHO GUIDELINES FOR ANTIBIOTIC STEWARDSHIP

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 ICMR GUIDELINES 2019
• What can the individual physicians do
• 1. Obtain appropriate cultures before starting antibiotic
• 2. Review antibiotic use after 48 – 72 hours : does it
need to be continued?
• 3. Stop antibiotic in patient with alternative non-
infectious diagnosis
• 4. Optimize dosing and duration of antibiotic therapy
• 5. Avoid unnecessary use, especially in viral upper
respiratory tract infections.
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GUIDELINES FOR PRESCRIBING
ANTIBIOTICS
(1) make an accurate diagnosis;

(2) use appropriate antibiotics and dosing schedules;

(3) consider using narrow-spectrum antibacterial drugs in simple infections to

minimize disturbance of the normal microflora, and preserve the use of broad-
spectrum drugs for more complex infections

(4) avoid unnecessary use of antibacterial drugs in treating viral infections;

American Dental Association Council on Scientific Affairs. Combating antibiotic resistance [published
correction appears in J Am Dent Assoc. 2004 Jun;135(6):727]. J Am Dent Assoc. 2004;135(4):484-487

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(5) if treating empirically, revise treatment regimen based on patient progress or test results;

(6) obtain thorough knowledge of the side effects and drug interactions of an antibacterial drug before

prescribing it;

(7) educate the patient regarding proper use of the drug and stress the importance of completing the full

course of therapy (that is, taking all doses for the prescribed treatment time).

 Furthermore, the diagnosis and antibiotic selection should be based on a thorough history (medical

and dental) to reveal or avoid adverse reactions, such as allergies and drug interactions.

American Dental Association Council on Scientific Affairs. Combating antibiotic resistance

[published correction appears in J Am Dent Assoc. 2004 Jun;135(6):727]. J Am Dent
Assoc. 2004;135(4):484-487 11
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 DOSE OPTIMIZATION
•
Attention to the dose of the antimicrobial is very important when treating an

infection.

• Dose optimization involves “optimization of antimicrobial dosing based on patient

characteristics (e.g., weight, renal/liver function), causative organism, site of infection

(e.g., central nervous system, blood) and pharmacokinetic and pharmacodynamics

characteristics of the drug (e.g., concentration or time dependent activity)…”

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 Factors
affecting dose
optimization
 PK/PD –Characteristics,
 Patient Characteristics,
 Causative Organism
 Site Of Infection.

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 Advantages
• Potentially improved microbiological
and clinical cure rates, including
improved mortality outcomes.
• Decreased risk of development of
resistance.
• Decreased risk of adverse events from
excess dosing (e.g., aminoglycoside
related nephrotoxicity).
• Avoidance of underdosing in obese
patients.
Disadvantages
•May be difficult to obtain patient-specific
information to make adjustments.
•Clinical trials that define optimal dosing and
administration schedules are not available for
all antimicrobials and indications
•Recommendations for dosing in special
populations are not always available or
consistent.
•Prolonged/continuous beta-lactam infusions
may be logistically difficult and labour-
intensive to implement.
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AWARNESS OF ANTIBIOTIC
STEWARDSHIP

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Antimicrobial stewardship in the community

• Delayed prescriptions

• Hand hygiene to reduce the spread of respiratory

and other pathogens

• Improved communication with patients

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 PATIENT EDUCATION
• Protecting individuals with vaccination
• Prevention of food born infections
• Explain to the public on the use antibiotics with
caution following the physicians advice

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  ABC’s of Antibiotics:

• Ask. Ask your healthcare provider, “Are these

antibiotics necessary?” 
• Bacteria. Antibiotics do not kill viruses. They
only kill bacteria. 
• Complete the course. Take all of your
antibiotics exactly as prescribed (even if you
are feeling better).
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Chennai Declaration

• Chennai Declaration was a

major step towards antibiotic
stewardship policy in India. The
aim was to initiate efforts to
formulate a policy to control
the rising trend of antimicrobial
resistance

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 Barriers in implementation of AMS
activities in developing countries- INDIA
• Lack of funding
• Lack of human resource
• Lack of information technology
• Higher priorities
• Lack of awareness among administrators
• Prescriber opposition
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 CONCLUSION
• Antimicrobial resistance has emerged as a global
health challenge and antibiotic stewardship is one of
the key strategies to prevent antimicrobial resistance.
• However , the success of antimicrobial stewardship
program depends on the joint efforts at the level of
community, patient, and the healthcare provider.

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 References
• Chennai Declaration Team. The Chennai Declaration: Recommendations of a
roadmap to tackle the challenge of antimicrobial resistance. A Joint Meeting of
Medical Societies of India. Indian J Cancer. 2012;49:84-94.
• Mani G, Annadurai K, Danasekaran R. Antimicrobial Stewardship: An Indian
Perspective. Online J Health Allied Scs. 2014;13(2):12.
• Bennadi, Darshana. Antimicrobial stewardship - An alarming call in dentistry.
International Journal of Pharmacy and Pharmaceutical Sciences. 2014; 6. 46-49.
• Chandy SJ, Michael JS, Veeraraghavan B, Abraham OC, Bachhav SS, Kshirsagar
NA. ICMR program on antibiotic stewardship, prevention of infection and
control (ASPIC). Indian J Med Res. 2014;139:226-30.

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