antibiotikastewardship

AntibiotikaStewardship, often called antibiotic stewardship, is a coordinated program that aims to optimize the use of antibiotics to treat infections effectively while minimizing unintended consequences such as adverse drug events and antimicrobial resistance.

Its core objectives include selecting appropriate antibiotic agents, doses, routes, and durations; narrowing therapy based on culture results when possible; avoiding unnecessary antibiotic use; and improving diagnostic accuracy and infection prevention practices.

Programs are typically led by a multidisciplinary team—physicians, clinical pharmacists, microbiologists, infection prevention specialists, nurses, and information technology experts—who develop guidelines, implement restrictions or preauthorization when needed, and conduct prospective audits with feedback.

Common strategies include evidence-based guidelines for empiric therapy, de-escalation to targeted therapy, dose optimization using pharmacokinetic/pharmacodynamic principles, and defined therapy durations. Tools such as preauthorization, formulary controls, and clinical decision support help standardize practice.

Metrics focus on process and outcomes, such as adherence to guidelines, days of therapy, defined daily doses, antibiotic consumption, resistance patterns, incidence of Clostridioides difficile infection, and patient outcomes.

Implementation settings range from hospitals to long-term care facilities and outpatient clinics, with similar goals but different operational challenges and resources.

Benefits include reduced antimicrobial resistance and adverse events, lower treatment costs, and improved patient outcomes; challenges include resource constraints, data integration, and changing prescribing culture.