Simi
Simeon Peter, B.Pharm, University of Papua New Guinea,
Papua New Guinea
Abstract: Antibiotics are a group of drugs that are taken in by a patient diagnosed with diseases that are caused by antimicrobials. Antibiotic stewardship is a systematic way to measure antibiotic effectiveness and efficacy by applying standardized methods to use the drugs, improve patients' outcomes, and reduce antibiotic resistance. This paper outlines the importance of having antibiotic stewardship at the national level in low and middle and middle-income countries.
INTRODUCTION
The Antibiotic Stewardship program is a cost-effective intervention to optimize the use of
antimicrobial medicine, improve patient outcomes, and reduce antimicrobial resistance (
AMR) Antibiotic stewardship is a systematic approach to educating and supporting
healthcare professionals to follow evidence-based and standardized guidelines for
prescribing and administering antibiotics for patients (WHO, 2021). It boosts the effort to
measure and improve how clinicians prescribe the antibiotics to be used by patients.
Centers for Disease Control and Prevention ( CDC) provides a core element of antibiotic
stewardship for the providers and facilities with a set of key principles to guide the approach
to improve antibiotic use to advance patient safety and improve outcomes. These
frameworks are developed for the guidelines and existing standards from the key healthcare
partner organizations and providers, including the Infectious Diseases Society of America,
the Society of Healthcare Epidemiology of America, the American Society of Health-System
Pharmacists, the Society of Infectious Diseases Pharmacists, and the Joint Commission.
CDCP’s core elements for antibiotic stewardship were created peculiarly for the U.S.
healthcare settings, however, the program is suitable to be adopted and implemented in
resource-limited settings that have fragile health systems and lack robust, regulatory
frameworks, particularly in low and middles income countries that are often affected by the
burden of irrational antibiotic use and advance the fight against AMR.
Body.
National-level antibiotic stewardship activities and policies are classified according to three
categories Basic, Intermediate, and Advanced categories (CDC, 2021). The basic level only
requires limited but substantial resources except for personal time and some technical
expertise. The intermediate level requires some resources, planning, and dedicated staff.
The advanced level requires legally-established programs with trained staff and dedicated
resources.
Basic-level national activities require the formation of national committees and teams with
clear terms and references to develop a national antibiotic stewardship action plan or policy;
convening and liaising with stakeholders; and reviewing the progress of these programs. The
national antibiotic stewardship action plans are vital tools for the country as they take the
broad stewards goals outlined in the WHO GAP and adapt them to their country's context.
Additionally, more antibiotic awareness campaigns drive behavior changes and improvement
in overall antibiotic use. Furthermore, policies are adopted requiring prescriptions for
antibiotics to prevent the widespread access to antibiotics without a prescription prevalent
in low and middle-income countries
Secondly, the intermediate level is required to develop and ensure access to recommended
formularies which consist of antibiotics that are suggested for certain healthcare settings. At
this level, it is a must that evidence-based standard treatment guidelines for common
clinical syndromes (sepsis, community-acquired pneumonia) are created ed and promoted.
Moreover, it provides diagnostic stewardship which ensures that patients get the right dose
at the right time. Finally, the Intermediate level requires that stewardship programs must be
included in undergraduate and graduate programs because some studies have shown that
such has been missing in most institution
The advanced level requires a formal and established program with a provision of dedicated
resources to enforce policies requiring prescriptions, track antibiotic dispensing using
available data set national targets for improvement, monitor antibiotic quality, and address
drivers for inappropriate prescribing behavior.
Low and middle-income countries have several challenges in implementing ASPs. These
include gaps in the viability of policies and guidelines, few infectious diseases and pharmacy-
specific training programs, weak data management systems, inexperience with data analysis,
and scars on human resources. The studies have shown that antibiotic stewardship programs
have not been taught in undergraduate and graduate programs. These challenges pose a
high risk of antibiotic resistance in healthcare settings
Conclusion
The antibiotic stewardship programs developed are to improve the clinical prescriptions and
the use of antibiotics by patients. The implementation of these programs in low and middle-
income countries requires a practical, high-impact strategy based on both expert opinion
and experience of successful implementation in other countries. The sustainability of the
programs requires the incorporation of the antibiotic stewardship program in schools
Reference
1. Okeke, I.N., et al., Antimicrobial resistance in developing countries. Part I: recent trends and
current status. The Lancet Infectious Diseases, 2005. 5(8): p. 481–493.
2. Organization, W.H., Antimicrobial resistance: global report on surveillance. 2014: Geneva,
Switzerland.
3. Gandra, S., et al., Trends in antibiotic resistance among major bacterial pathogens isolated from
blood cultures tested at a large private laboratory network in India, 2008–2014. International Journal
of Infectious Diseases. 50: p. 75–82.
4. Organization, W.H., Global Action Plan on Antimicrobial Resistance. 2015: Geneva.
5. Nowak, M.A., et al., Clinical and economic outcomes of a prospective antimicrobial stewardship
program. American Journal of Health-System Pharmacy, 2012. 69(17): p. 1500–1508.
6. Kaki, R., et al., Impact of antimicrobial stewardship in critical care: a systematic review. J
Antimicrob Chemother, 2011. 66(6): p. 1223–30.
7. Pollack, L.A. and A. Srinivasan, Core elements of hospital antibiotic stewardship programs from
the Centers for Disease Control and Prevention. Clin Infect Dis, 2014. 59 Suppl 3: p. S97–100.
8. CDC, Implementation of Antibiotic Stewardship Core Elements at Small and Critical Access
Hospitals, N.C.f.E.a.Z.I. Diseases, Editor. 2017: Atlanta, GA.
9. Sanchez, G.V., et al., Core Elements of Outpatient Antibiotic Stewardship. MMWR Recomm Rep,
2016. 65(6): p. 1–12.
10. Mendelson, M., et al., Maximising access to achieve appropriate human antimicrobial use in low-
income and middle-income countries. Lancet, 2016. 387(10014): p. 188–98.
11. Bebell, L.M. and A.N. Muiru, Antibiotic Use and Emerging Resistance: How Can Resource-Limited
