Antibiotic stewardship refers to the practice of responsibly administering antibiotics to those patients who genuinely need them, to treat some kind of disease or potentially lethal infection. In the past, these kinds of health issues may have been fatal to some patients, but with the advent of antibiotics, they have become readily treatable. However, studies have shown that as much as 50% of all antibiotics prescribed in the U.S. are either unnecessary or inappropriate for the medical condition for which they are prescribed.

One of the most frightening by-products of this kind of misuse is the development of antibiotic resistance. The spread of resistant organisms can cause patients who are not even using antibiotics to develop health issues. The Center for Disease Control (CDC) has estimated that at least 2 million people annually are currently infected with organisms capable of resisting antibiotics. The CDC further estimates that this situation results in the deaths of 23,000 individuals each year. From this, it can be seen that antibiotic stewardship is a major issue in this country, and that it calls for serious attention.

Antibiotic stewardship in hospitals

It has become clear that antibiotic stewardship is critically important in hospital settings, so as to optimize the treatment of infections and to reduce any adverse effects associated with using antibiotics. Programs for antibiotic stewardship have already been implemented in many hospitals, since they consistently help improve the quality of patient care, while reducing treatment failures.

These kinds of programs have also resulted in an increased frequency of correct prescriptions for diseases they are intended to treat. Where such programs have been implemented, the incidence of antibiotic resistance is much lower, and for this reason alone, it is well worth implementing a program of antibiotic stewardship.

Basic elements of an antibiotic stewardship program

There are a number of core elements which make up a good antibiotic stewardship program, including all of the following:

• education – educating health personnel about antibiotic resistance, as well as the importance of writing accurate prescriptions
• commitment from leadership – support from management to ensure that resources are dedicated to the program
• action – implementing recommended procedures such as evaluations of ongoing treatments
• accountability – appointing one person to be the overall champion for the antibiotic stewardship program. Ideally, this person should be a medical professional who is totally familiar with the history of antibiotic usage.
• tracking – systematic monitoring of antibiotic prescriptions as well as any patterns of resistance which appear
• drug expertise – empowering one pharmacist to serve as leader, with regard to improving usage of antibiotics
• reporting – consistent and periodic reporting of all information relative to antibiotic usage and antibiotic resistance to all medical personnel on staff.

Policies to be adopted

There are several broad policies which should be adopted as part of an antibiotic stewardship program that can have an immediate impact on improving antibiotic usage. The first of these is known as an ‘antibiotic timeout’, and it involves revisiting the choice of antibiotics administered to an incoming patient. Quite often, when a patient is first admitted to a hospital with a disease or infection, they are administered an antibiotic which is thought to be appropriate for the issue.

An antibiotic timeout calls for revisiting this prescription after 48 hours to determine the effectiveness of the original prescription. At this time, it should be positively determined that the patient has an infection which will respond to antibiotics, and that the right drug was prescribed. If not, then a more targeted antibiotic should be prescribed and a definite treatment period should be established.

Another important part of an antibiotic stewardship program is to have on hand an expert in antibiotic usage and infectious diseases. This will ensure that the appropriate medication is used to treat whatever disease or infection a patient might have. Lastly, as with almost any other kind of program, an antibiotic stewardship program should be audited, with feedback provided to those in charge. Reviews of the program should be externally conducted by experts in antibiotic usage, rather than by the treatment team administering the antibiotics.

Non-hospital antibiotic stewardship

Antibiotic stewardship is an important concept in medical facilities outside the hospital setting, including dental facilities. At Good Samaritan Dental Implant Institute, antibiotic usage is taken very seriously, and we do our best to prescribe the appropriate  medication for the treatment of any dental infections or diseases. Like any responsible medical facility, we insist on doing our part to carry out effective antibiotic stewardship to ensure the ongoing health of all of our patients.