Antibiotic stewardship

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

ABS; Antimicrobial stewardship

Definition
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Antibiotic Stewardship (ABS) describes a broad-based (international) concept for the responsible, targeted use of antibiotics in infectious diseases. By its very nature, ABS is dependent on national or regional conditions due to differences in health systems and health standards (Dyar OJ et al. 2017: we suggest viewing antimicrobial stewardship as a strategy, a coherent set of actions which promote using antimicrobials responsibly. We stress the continuous need for 'responsible use' to be defined and translated into context-specific and time-specific actions)

The German Society for Infectiology (DGI) describes ABS as "a programmatic, sustained effort by a medical institution to improve and ensure rational anti-infective prescription practice with strategies or measures that ensure the quality of anti-infective treatment in terms of selection, dosage, application and duration of use in order to achieve the best clinical outcome while minimizing patient toxicity".

General information
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Among the various groups of drugs, antibiotics can cause side effects - some of which are not insignificant - and can also contribute to the development of resistance. Their use must therefore be weighed up particularly carefully. The development of resistance after the use of antibiotics initially affects the individual patient, in whom the bacteria that have become resistant can later cause disease and are then more difficult to treat with antibiotics (Septimus EY 2018).

However, these pathogens can also be transmitted - directly or via the environment - to other individuals and then cause disease in these individuals and make them more difficult to treat. This makes the development of resistance a general, worldwide health problem (public health problem), also due to the high mobility of the population.

The use of antibiotics in livestock breeding plays an important special role; antibiotics are not only used for the immediate treatment of infections, but also for prophylaxis and animal fattening (Lloyd D et al. 2018: The antimicrobial stewardship program for veterinary use integrates infection prevention and control together with approaches emphasizing avoidance of antimicrobial agents). Note: In 2017, 733 tons of antibiotics were fed to chickens, pigs, cows and other farm animals). The increasing use of reserve antibiotics in livestock breeding also aggravates the general and increasing resistance problem.

ABS refers to a programmatic, sustained effort by a medical institution to improve and ensure rational anti-infective prescription practice. This means strategies or measures that ensure the quality of anti-infective treatment in terms of selection, dosage, application and duration of use in order to achieve the best clinical outcome while minimizing toxicity to the patient (Septimus EY 2018). ABS programs that combine several ABS measures have a positive influence on resistance, cost and consumption trends. Thus, ABS has a clear objective, namely to prevent or reduce infectious diseases or deaths caused by resistant bacteria (33,000 people die every year in Europe from infections caused by multi-resistant germs). This programmatic objective includes targeted measures to reduce resistant bacteria in an affected individual but also in his environment. This can only be achieved by reducing the use of antibiotics on the one hand and by their targeted use on the other (Rice LB 2018).

Health policy framework: ABS can be used wherever antibiotics are prescribed, such as in in-patient and out-patient medicine (about 80% of antibiotics used in humans are prescribed in the out-patient sector) and in veterinary medicine. There is now an awareness of the need for ABS at all levels of health policy worldwide. The World Health Organization (WHO), the European Centre for Disease Prevention and Control (ECDC), the respective national health authorities (in Germany the Robert Koch Institute -RKI), but also various non-governmental organizations (NGOs) are programmatically involved. In this context, it is important to formulate standards that can be applied in both industrialized and non-industrialized countries (see also antibiotics, instructions for therapy). By their very nature, the measures cover a broad spectrum of interdisciplinarity. In addition to the individual disciplines of human medicine and veterinary medicine and their representatives, microbiology is always included, since it provides information on pathogens and their possible resistance in individual patients.

Literature
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  1. DGI (German Society for Infectiology): Definition Antibiotic Stewardship: https://www.dgi-net.de/fort-und-weiterbildung/antibiotic-stewardship-abs/
  2. Dyar OJ et al.(2017) What is antimicrobial stewardship? Clin Microbiol Infect 23: 793-798
  3. Lloyd D et al (2018) Antimicrobial Stewardship in Veterinary Medicine. Microbiology spectrum 6: 10.1128/microbiolspec.ARBA-0023-2017.
  4. Rice LB (2018). Antimicrobial Stewardship and Antimicrobial Resistance. The Medical clinics of North America 102: 805-818.
  5. Septimus EJ (2018) Antimicrobial Resistance: Antimicrobial/Diagnostic Stewardship and Infection Prevention Approach. The Medical clinics of North America 102:819-829.
  6. Stalder S et al (2018). Descriptive study on antibiotic-free milk production in cattle Swiss Archives of Veterinary Medicine 160: 727-736

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Last updated on: 29.10.2020