The last decade has seen increasing awareness and research activities regarding antibiotic stewardship.1,2 Several countries and institutions have succeeded in limiting the spread of antibiotic resistance by interventions such as restrictive or persuasive antimicrobial stewardship, public health campaigns, governmental regulations and improved diagnostics.3,4 Nevertheless, although there is strong agreement that antibiotic overuse is a critical driver of antibiotic resistance, the definition and indicators of its opposite, ‘responsible’ antibiotic use, remain imprecise and controversial.
The 3 year DRIVE-AB (Driving Re-InVEstment in R&D and responsible AntiBiotic use) research project, funded by the Innovative Medicines Initiative and composed of 23 public and private partners from 12 countries, was set up to study and improve incentives and policies to stimulate innovation, sustainable use and equitable availability of novel antibiotics to meet unmet public health needs.5–7 In one of its main work activities, the DRIVE-AB consortium was commissioned to develop an evidence-based consensus definition and framework for ‘responsible antibiotic use’, with standardized quality and quantity measures. Using a number of research methodologies, including systematic reviews, structured stakeholder consultations and in-depth case studies of typical scenarios of antibiotic use, this work package was able to produce important output that will provide useful guidance for clinicians, pharmacists and policy makers around the world.
In this Supplement to Journal of Antimicrobial Chemotherapy, DRIVE-AB’s working group on responsible antibiotic use presents six research articles (see Preface) that address an urgent need: how to define and measure responsible and adequate antibiotic prescribing in inpatient and outpatient settings, including both quantity metrics and quality indicators. Many healthcare providers and policy makers require this essential background information to shape specific antibiotic stewardship recommendations and adapt monitoring of their implementation. Furthermore, these reviews provide practical help and recommend measures that will help to guide the surveillance of appropriate use of not only marketed drugs but also novel antibiotic agents targeted at multiresistant bacteria. Together, these six articles provide an overview of current evidence and measures to guide the surveillance of responsible antibiotic usage in different settings. Ultimately, they will help in the fight against infections caused by resistant bacteria.
Acknowledgements
DRIVE-AB is supported by the Innovative Medicines Initiative Joint Undertaking under the DRIVE-AB grant agreement no. 115618, resources of which are composed of financial contribution from the European Union’s 7th Framework Programme and EFPIA companies’ in-kind contribution.
Transparency declarations
S. H. and J. H. are the coordinators of the DRIVE-AB consortium. S. H. reports having received peer-reviewed research grants funded by Pfizer and B. Braun; he is also a member of the advisory board of Bayer, Novartis and DNA Electronics. J. H. is an employee of, and owns stock options in, AstraZeneca. This article forms part of a Supplement sponsored by DRIVE-AB.
References
- 1. Fishman N. Antimicrobial stewardship. Am J Med 2006; 119: S53–61. [DOI] [PubMed] [Google Scholar]
- 2. Owens RC., Jr. Antimicrobial stewardship: concepts and strategies in the 21st century. Diagn Microbiol Infect Dis 2008; 61: 110–28. [DOI] [PubMed] [Google Scholar]
- 3. Huttner B, Harbarth S, Nathwani D.. Success stories of implementation of antimicrobial stewardship: a narrative review. Clin Microbiol Infect 2014; 20: 954–62. [DOI] [PubMed] [Google Scholar]
- 4. Oberje EJM, Tanke MAC, Jeurissen PPT.. Antimicrobial stewardship initiatives throughout Europe: proven value for money. Infect Dis Rep 2017; 9: 6800.. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Mullard A. Momentum builds around new antibiotic business models. Nat Rev Drug Discov 2014; 13: 711–3. [DOI] [PubMed] [Google Scholar]
- 6. Harbarth S, Theuretzbacher U, Hackett J. et al. Antibiotic research and development: business as usual? J Antimicrob Chemother 2015; 70: 1604–7. [DOI] [PubMed] [Google Scholar]
- 7. Kostyanev T, Bonten MJ, O'Brien S. et al. The Innovative Medicines Initiative’s New Drugs for Bad Bugs programme: European public–private partnerships for the development of new strategies to tackle antibiotic resistance. J Antimicrob Chemother 2016; 71: 290–5. [DOI] [PubMed] [Google Scholar]