The World Health Organization (WHO) defines the appropriate use of antimicrobials as “the cost effective use of antimicrobials which maximises clinical therapeutic effect while minimising both drug-related toxicity and the development of antimicrobial resistance”. 

In a 2013 report by chief medical officer (CMO) Professor Dame Sally Davies regarding infections and the rise of antimicrobial resistance, the following description is used: antimicrobial stewardship “embodies an organisational or healthcare-system-wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness”. It has three major goals:

1. Optimise therapy for individual patients
2. Prevent overuse, misuse and abuse
3. Minimise development of resistance at patient and community levels. 

Pharmacy professionals can support these aims through dialogue with prescribers about appropriate choice of antibacterial and by ensuring patients are referred to prescribers appropriately, counselled about how and when to take their antibiotic and possible side effects to expect, so that treatment is not stopped prematurely.

Reducing resistance 

The CMO’s report highlights concerns that the increasing levels of organisms’ resistance to antimicrobial agents and the decreasing number of new agents in development will lead to a health threat. The report highlights the need to preserve existing antimicrobial agents by good stewardship and encourages development of new agents. 

Areas for action include prioritising antimicrobial resistance as a major area of concern, educating healthcare professionals and the public to encourage responsible use of antibacterials, and improving prevention, diagnostic technology and surveillance.

Practice point 2

Clostridium difficile and MRSA have become major infections because of inappropriate antibacterial use.

Discuss this statement.