ANTIMICROBIAL STEWARDSHIP
ANTIMICROBIAL
STEWARDSHIP
AND YOU
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The dire economic consequences of AMR
cannot be overstated. The World Bank
has estimated that, by 2050, AMR will
result in global economic damage at least
equivalent to the financial collapse of
2008 if left unchallenged, and no country
will be spared. While profound, financial
loss estimates fail to consider the human
and environmental health aspects.
Whether from concern about personal
health, patient health, effective practice
of veterinary medicine, animal welfare or
food production, all veterinarians need to
be motivated and engaged in preserving
effective antimicrobials
WHAT IS ANTIMICROBIAL
STEWARDSHIP?
Antimicrobial stewardship is a
coordinated approach to optimizing
the use of antimicrobials, maximizing
patient care and while minimizing the risk
of resistance, toxicity or other adverse
events. This involves a multifaceted
approach to determine when to
prescribe antimicrobials, what drug, dose
and duration, how they are administered
and whether other approaches are
needed in addition to or in lieu of
antimicrobials (e.g. surgery, wound care,
management of underlying disease).
While the concept of antimicrobial
stewardship is now attracting much
attention, there is sometimes the
perception that an antimicrobial
stewardship program (ASP) is meant to
be restrictive and will therefore negatively
impact the practice of veterinary
medicine. While some aspects of an
ASP may implement controls, an ASP is
not meant to complicate patient care,
remove access to needed antimicrobials
or decrease practice efficiency. Rather, a
well-structured and functioning ASP can
improve patient care and facilitate timely
and effective treatment.
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College Connection Fall 2019 cvo.org
CORE COMPETENCIES OF
ANTIMICROBIAL STEWARDSHIP
Antimicrobial stewardship is a multi-modal approach to the practice of
medicine that goes beyond specific aspects of antimicrobial use.
While an antimicrobial stewardship
program (ASP) obviously has a major
emphasis on specific aspects of drug
prescription and use, it is much more.
A strong ASP has broader aspects to
reduce the need for antimicrobials
through preventing disease and
promptly identifying patients that require
antimicrobials and those that do not.
It fosters communication with and the
education of all players in the prescribing
cascade (attending clinician, diagnostic
laboratory, pharmacy, owner) to facilitate
optimal use and remove pressures to use
antimicrobials in situations where they
are not indicated.
Virtually all clinicians practice some form
of antimicrobial stewardship on a daily
basis, through decisions about when and
how to use antimicrobials, and through
measures taken to reduce the risk of
disease. Therefore, implementation of
an ASP should not be approached as a
paradigm shift, but rather an evolution of
core principles of medicine.
There is a wide range of potential
components of an antimicrobial
stewardship program (Table 1 - page
3). The feasibility and potential benefits
of these vary, with some representing
rather easy-to-implement and potentially
high yield measures, and others that
can be categorized as useful to more
complex and lower priority.
A few examples of important concepts
or issues are outlined below. Further
components of ASPs will be outlined in
future articles.
Treatment guidelines
Properly developed treatment guidance
can assist clinicians with the most
effective and appropriate therapy,
including whether/when to use an
antimicrobial and optimal antimicrobial
drugs and regimens.
Guideline development in veterinary
medicine lags behind human medicine,
and most available guidelines are
formed largely based on expert opinion.
Regardless, well-structured guideline
development, even with limited high
level data, can provide good guidance
and clinical guidelines are increasingly
available.
Communications
While not often thought of as a specific
approach, communication is a critical
aspect of any ASP. This can involve
communicating with clients to explain
why antibiotics are or are not needed,
discussing the importance of compliance
and emphasizing the importance of
complementary practices (e.g. addressing
underlying allergic skin disease in dogs
with bacterial pyoderma).
Infection prevention and control
The best way to prevent antimicrobial
resistant infections is to prevent
infections. Reducing disease reduces
the need for antimicrobials, and their
corresponding risks.
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