Antimicrobial stewardship program activities in India: an appraisal
Keywords:Antimicrobial, Rational antibiotic use, AMSP, IPC, AMRSN, India
Human antimicrobial misuse/overuse/irrational use is one of the main drivers of antimicrobial resistance (AMR) and in the presence of a rapidly drying up antibiotic pipeline, it becomes imperative that we learn to use antibiotics judiciously and responsibly. In 2010, India was adjudicated to be the world’s largest consumer of antibiotics and hence curbing injudicious use of antibiotics is a must. Antibiotic abuse happens due to common fallacies such as a belief that broad spectrum antibiotics are “safer” and failure to distinguish between bacterial infections and non-bacterial infections and non-infectious syndromes. In addition, antibiotics for durations longer than necessary, redundant cover (like double gram negative or double anaerobic cover) or treatment of colonizers or contaminants also constitute inappropriate antibiotic use. A stewardship program implementing rational antibiotic use is mandatory to curb irrational antibiotic use. Antimicrobial stewardship is defined as a set of coordinated interventions designed to measure and improve the appropriate use of antibiotics by promoting the selection of the optimal choice, dose, duration and route of the antibiotic which in turn lead to improved patient outcomes and decreased adverse effects.
Storr J, Twyman A, Zingg W, Damani N, Kilpatrick C, Reilly J, et al. Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations. Antimicrob Resistance Infect Control. 2017;6(1):1-8.
Ho L, Melvani S. Serial point‐prevalence studies to investigate hospital antimicrobial prescribing. J Pharm Pract Res. 2007;37(3):190-3.
Pollack LA, van Santen KL, Weiner LM, Dudeck MA, Edwards JR, Srinivasan A. Antibiotic stewardship programs in US acute care hospitals: findings from the 2014 National Healthcare Safety Network Annual Hospital Survey. Rev Infect Dis. 2016;63(4):443-9.
O’Leary EN, van Santen KL, Webb AK, Pollock DA, Edwards JR, Srinivasan A. Uptake of antibiotic stewardship programs in US acute care hospitals: findings from the 2015 National Healthcare Safety Network Annual Hospital Survey. Clin Infect Dis. 2017;65(10):1748-50.
Álvarez-Lerma F, Grau S, Echeverría-Esnal D, Martínez-Alonso M, Gracia-Arnillas MP, Horcajada JP, Masclans JR. A before-and-after study of the effectiveness of an antimicrobial stewardship program in critical care. Antimicrob Agents Chemotherap. 2018;62(4):e01825-17.
Zhou Y, Wushouer SH, Zhang X, Feng J, Lin L, Zheng B, Guan X. Luwen Antimicrobial stewardship program in China’s tertiary hospitals in 2018: a nationwide cross-sectional online survey. 2020.
Huttner B, Harbarth S, Nathwani D, ESCMID Study Group for Antibiotic Policies. Success stories of implementation of antimicrobial stewardship: a narrative review. Clin Microbiol Infect. 2014;20(10):954-62.
Kumar SG, Adithan C, Harish BN, Sujatha S, Roy G, Malini A. Antimicrobial resistance in India: A review. J Natural Sci Biol Med. 2013;4(2):286.
Centers for Disease Control and Prevention. Core elements of hospital antibiotic stewardship programs, 2014 Atlanta, GA: CDC. 2014. Available at: https://www.cdc.gov/antibiotic-use/core-elements/hospital.html. Accessed on 12 June 2022.
Morris AM, Brener S, Dresser L, Daneman N, Dellit TH, Avdic E, Bell CM. Use of a structured panel process to define quality metrics for antimicrobial stewardship programs. Infect Control Hospital Epidemiol. 2012;33(5):500-6.
Gandra S, Mojica N, Klein EY, Ashok A, Nerurkar V, Kumari M, et al. Trends in antibiotic resistance among major bacterial pathogens isolated from blood cultures tested at a large private laboratory network in India, 2008-2014. Int J Infect Dis. 2016;50:75-82.
Walia K, Ohri VC, Mathai D. Antimicrobial stewardship programme (AMSP) practices in India. Indian J Med Res. 2015;142(2):130.
Ohl CA, Luther VP. Antimicrobial stewardship for inpatient facilities. J Hosp Med. 2011;6.
McGowan JE. Antimicrobial stewardship—the state of the art in 2011 focus on outcome and methods. Infect Control Hospital Epidemiol. 2012;33(4):331-7.
Beganovic M, LaPlante KL. Communicating with Facility Leadership; Metrics for Successful Antimicrobial Stewardship Programs (Asp) in Acute Care and Long-Term Care Facilities. R I Med J. 2018;101(5):45-9.
Van Boeckel TP, Gandra S, Ashok A, Caudron Q, Grenfell BT, Levin SA, Laxminarayan R. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lancet Infect Dis. 2014;14(8):742-50.
O'Neill J. Tackling drug-resistant infections globally: final report and recommendations. The review of antimicrobial resistance. 2016.
Ghafur A, Mathai D, Muruganathan A, Jayalal JA, Kant R, Chaudhary D, et al. The Chennai Declaration: a roadmap to tackle the challenge of antimicrobial resistance. Indian J Cancer. 2013;50(1):71.
Government of India. National action plan on antimicrobial resistance. 2017. Available at: https://ncdc.gov.in/WriteReadData/l892s/File645.pdf. Accessed on 12 May 2022.