Antimicrobial stewardship

Antimicrobial stewardship is the systematic effort to educate and persuade prescribers of antimicrobials to follow evidence-based prescribing, in order to stem antimicrobial overuse, and thus antimicrobial resistance. AMS has been an organized effort of specialists in infectious diseases, both in Internal Medicine and Pediatrics with their respective peer-organizations, hospital pharmacists, the public health community and their professional organizations since the late 1990s. It has first been implemented in hospitals. In the U.S., within the context of physicians' prescribing freedom (choice of prescription drugs), AMS had largely been voluntary self-regulation in the form of policies and appeals to adhere to a prescribing self-discipline until 2017, when the Joint Commission prescribed that hospitals should have an Antimicrobial Stewardship team, which was expanded to the outpatient setting in 2020. As of 2019, California and Missouri had made AMS programs mandatory by law. The 2007 definition by the Society for Healthcare Epidemiology of America (SHEA) defines AMS as a "set of coordinated strategies to improve the use of antimicrobial medications with the goal to enhance patient health outcomes, reduce antibiotic resistance, and decrease unnecessary costs". Decreasing the overuse of antimicrobials is expected to serve the following goals: improve patient outcomes, especially patient safety decrease adverse drug reactions such as hypersensitivity reactions or kidney or heart damage (e.g., QT prolongation). decrease antibiotic-associated disease, such as Clostridium difficile–associated diarrhea, other antibiotic-associated diarrheas, and invasive candidiasis guard the patient's microbiome, including the gut flora, respiratory tract flora, urogenital tract flora, and skin flora (this is closely related to the preceding goal of preventing antibiotic-associated disease) decrease wasted costs slow the increase in antimicrobial resistance prevent unforeseen environmental degradation, such as likely adverse effects of altering biotas and animal microbiotas by pervading the water cycle with antimicrobials in wastewater Antimicrobial misuse was recognized as early as the 1940s, when Alexander Fleming remarked on penicillin's decreasing efficacy, because of its overuse.