Table 3. Main antimicrobial stewardship strategies recommended in the international literature to improve antibiotic use at the hospital level.1,49.
Educational measures and active interventions | |
---|---|
Passive educational measures |
• Developing/updating local antibiotic guidelines • Educational sessions, workshops, local conferences |
Active interventions |
• Clinical rounds discussing cases • Prospective audit with intervention and feedback • Reassessment of antibiotic prescriptions, with streamlining and de-escalation of therapy • Academic detailing, educational outreach visits |
Restrictive measures |
• Limiting number of antibiotics on the hospital formulary • Antibiotic order form (compulsory) • Automatic stop order • Formulary restriction and preauthorization • Limiting reporting of susceptibilities by the microbiology laboratory • Regulating contacts with the pharmaceutical industry |
Supportive/supplemental measures | • Multidisciplinary antimicrobial stewardship team • Consultancy service (infectious diseases, pharmacy, microbiology) • Computer-assisted management program • Parenteral to oral conversion • Therapeutic drug monitoring service |