Stewardship Is Key to Proper Antibiotic Use, Experts Say

Experts have called for stepped-up vigilance in antibiotic use through widespread implementation of antimicrobial stewardship programs. (Image: Dimitris66/

More than 65 years after the first penicillin-resistant microbes were detected, infectious disease experts today issued a policy statement calling for more vigilant use of antibiotics as threats from drug-resistant bacteria mount while the effectiveness of currently available antimicrobials dwindles.

The statement, published in Infection Control and Hospital Epidemiology, is part of a special issue of the journal devoted to antimicrobial stewardship—programs and practices that guide physicians in deciding when to prescribe antibiotics and choosing the best options for a given patient.

The statement, a joint effort of the Society of Healthcare Epidemiology of America, the Infectious Diseases Society of America, and the Pediatric Infectious Diseases Society, emphasizes antibiotic resistance as a critical public health threat.

“The antimicrobial armamentarium has been depleted and our ability to treat infectious diseases has been severely compromised,” the authors wrote. “It is ironic that in the 21st century we are encountering bacterial infections for which we have no treatment.”

The statement recommends initiatives to use antibiotics appropriately, including the following:

• The Centers for Medicare & Medicaid Services (CMS) should require participating health care institutions to develop and implement physician-directed antimicrobial stewardship programs.

• The CMS and other federal agencies, including the Centers for Disease Control and Prevention and the National Institutes of Health, should fund pilot projects to introduce stewardship programs in ambulatory care settings.

• Antimicrobial resistance and stewardship should be required in curricula for medical students, residents, and fellows; practicing clinicians also should become proficient in these areas.

• Researchers should define appropriate and inappropriate antibiotic use and design multicenter, randomized studies examining the effects of various stewardship programs.

Editors of the special issue also called stewardship programs “economically attractive.”

The issue includes a study showing that an antimicrobial stewardship program established in 2001 at the University of Maryland Medical Center (UMMC) in Baltimore saved the hospital $3 million in its first 3 years. In 2008 the program was discontinued in favor of using more infectious diseases consults. Over the next 2 years, antimicrobial costs increased by 32%, representing $2 million in added costs for the medical center.

“Investing in stewardship not only helps preserve our dwindling antibiotic tools, it can also help to eliminate wasteful health care spending,” lead author Harold Standiford, MD, of UMMC, said in a news release.

Categories: Bacterial Infections, Infectious Diseases, Public Health