Antimicrobial Stewardship (AMS) in the Community

The importance of improving outpatient antibiotic use is acknowledged, but no comprehensive recommendations to curb the use in this setting have been made because of the lack of sufficient data to guide such efforts. A targeted application of antimicrobial stewardship (AMS) principles to the ambulatory setting has the potential to affect the most common indications for systemic antibiotic use in that the majority (80%) of antibiotic use occurs in the community, with acute respiratory-tract infections being the most common indication. However, the reasons driving the excessive prescription of antibiotics in the community are complex and include constraints on the consultation time, the lack of appreciation of the impact on resistance, considerable diagnostic uncertainty, and perhaps most importantly patient and parental pressures in conjunction with patient satisfaction surveys. Thus, in contrast to institutionalized AMS, few recommendations for outpatients are offered, largely because of the paucity of data regarding effective interventions to tackle such complex issues in ambulatory care. Prescribing antibiotics for patients with self-limiting conditions is counterproductive as it reinforces the belief that antibiotics are beneficial and encourages repetitive prescriptions and consultations. Hence, one of the ultimate goals of a community AMS program should be “demedicalization” of self-limiting acute infections. In this regard, multifaceted interventions where education...
Source: Clinical Pulmonary Medicine - Category: Respiratory Medicine Tags: Respiratory Infections Source Type: research