A review of the role of antibiotic policies in the control of antibiotic resistance

Abstract

The optimal antibiotic control measures remain to be described and probably vary between institutions. Nevertheless, various control measures have been shown to be useful in reducing costs of therapy and total amounts of prescribing, while maintaining quality of care. More recently, interest has turned to whether antibiotic policies can reduce the spread of resistance and even reverse current high levels. Early studies indicated this was feasible, but mathematical models and the recent discovery of the role of transposons and integrons in multi-drug resistance have both cast doubt on likely future success in this area. Nevertheless, there have been some major successes in recent studies, both in the community and hospital. While cross-infection is a major impediment to control of resistance, there is little doubt that careful antibiotic prescribing can curtail the emergence and reduce the prevalence of resistance.

Reliability of assessment of adherence to an antimicrobial treatment guideline

“…Prudent use might curb development of new resistant bacteria and reduce prevailing antimicrobial resistance. [1][2][3] Programmes to optimize antimicrobial use have reduced the cost and volume of therapy while optimizing care. [4][5][6] Adherence to hospital antibiotic guidelines is a commonly used primary outcome measure in studies of antimicrobial treatment patterns.…”

Optimización del tratamiento antibiótico mediante la participación de expertos en antibióticos

“…Una variedad de estos programas consiste en establecer una lista de antibióticos restringidos cuya administración requiere una autorización previa (3,6,7,10,11). Uno de los problemas de este enfoque es que el clínico prescriptor puede contemplarlo como una mera traba burocrática, pudiendo existir, además, el riesgo de atribuir a una determinada restricción antibiótica una potencial mala evolución de un caso particular (2,12).…”

Minimum antibiotic stewardship measures

“…Using data on the baseline risk of infection and the efficacy of prophylaxis (odds ratio) one can calculate the numbers to be given prophylaxis to prevent a case of post operative infection. The criteria of whether prophylaxis will increase or decrease a Units antibiotic consumption may be helpful in reaching a policy decision, based on a Units total antibiotic exposure being a key factor in likely resistance problems (14).…”

“…While there is a case for diversity in antibiotic use, which argues against the restriction of formularies in terms of selecting resistance (14), cost savings in bulk purchase and the ability to limit use of inappropriate antibiotics argue for their extended use (11, 15).…”