AntibiotikaStewardshipStrategie

Antibiotika-Stewardship, often referred to as antimicrobial stewardship, is a systematic approach within healthcare settings to optimize the use of antibiotics. The aim is to ensure effective treatment of infections while minimizing adverse effects, resistance development, and unnecessary costs.

Key components include strong leadership and accountability, a dedicated stewardship team (typically including an infectious diseases physician, a clinical pharmacist, and microbiology or infection prevention staff), and evidence-based practices such as formulary restrictions, preauthorization for certain agents, and guideline-based empiric therapy with regular review of therapy (prospective audit and feedback). Additional actions include de-escalation based on microbiology results, dose optimization, IV-to-oral switch when appropriate, and duration-limited therapy.

Measurement and feedback are central. Programs track antibiotic consumption, infection outcomes, resistance patterns, and adverse events, using metrics such as defined daily dose and days of therapy. Data are used to guide adjustments and provide feedback to prescribers. In many countries, guidelines and stewardship programs are backed by public health agencies and professional societies.

Applications span hospitals, long-term care facilities, and outpatient clinics. Successful stewardship reduces inappropriate use, lowers rates of antimicrobial resistance and Clostridioides difficile infection, and can shorten hospital stays and costs.

Challenges include resource limitations, data integration, and changing prescribing culture. The development of rapid diagnostics, point-of-care testing, and regional collaboration are expected to enhance effectiveness in the future.