How to educate prescribers in antimicrobial stewardship practices

Abstract

Widespread antimicrobial use has compromised its value, leading to a crisis of antimicrobial resistance. A major cause of misuse is insufficient knowledge of prescribing of antimicrobials in many categories of professionals. An important principle of antimicrobial stewardship is avoiding selection pressure in the patient, both on pathogen and commensal by avoiding unnecessary use, choosing the least broad-spectrum antibiotic, adequate doses, a good timing and the shortest possible duration. Up to now, most educational efforts have been targeted at professionals (mostly medical doctors) after their training and at the adult public. In the past few years, progress has been made in educating children. It is now crucial that academia and ministries of Health and Education jointly focus on an adapted undergraduate medical/professional curriculum that teaches all necessary principles of microbiology, infectious diseases and clinical pharmacology, with emphasis on the principles of prudent prescribing.

Keywords: antibiotic policies; antibiotic prescribing; antimicrobial stewardship; clinical practice guidelines; implementation; intervention strategies; postgraduate education; undergraduate curriculum.

Figure 1. The pyramid of infectious diseases. It describes the complex interrelationship between humans, microorganisms and antimicrobial drugs. The arrows in the pyramid illustrate the multiple interactions between the patient, the drug, the pathogen(s) and colonizing microflora. Activity of the antimicrobial drug is obtained at the cost of the development of resistance by the pathogen, but also the colonizing flora.

Figure 2. Timeline of education on prudent antibiotic use. Different time periods which offer opportunities to shape or change the behavior of the public and the prescribers of antibiotics