Antimicrobial Stewardship Programs as a Means to Optuimize Anitmicrobial Use

Robert C. Owens, Jr., Pharm.D.; Gilles L. Fraser, Pharm.D., FCCM; Patricia Stogsdill, MD


Pharmacotherapy. 2004;24(7) 

In This Article

Antimicrobial Stewardship Programs: Overview of the More Recent Literature

Because the practice of managing antimicrobial agents has changed significantly over the last 2 decades, our intent was not to review the epic antimicrobial stewardship program literature. An article published in 1997 did a noteworthy job of this in primarily focusing on cost savings and remuneration.[21] Our review covers publications and presentations over the last few years that were selected to illustrate the diversity of methods and outcomes measured ( Table 1 ).[18,19,20,22,23,24,25,26,27,28,29,30]

The use of the term antimicrobial stewardship program implies a multidisciplinary, programmatic, prospective, interventional approach to optimizing the use of antimicrobial agents. A variety of prospective, programmatic strategies have been proposed, but in reality, they can be simplified into one of two main categories: prior authorization and concurrent review with feedback. Of course, the two are not mutually exclusive, and hybrid programs using a blend of the central strategies have been created.

One study demonstrated that among similarly matched hospitals, only the programmatic, prospective, interventional programs significantly affected parenteral antimicrobial use patterns and costs in contrast to institutions that relied solely on passive strategies.[31] These passive or adjunctive interventions, in our minds, may serve as tools to augment the two main strategies. These interventions include the use of stop orders, antibiotic order forms, closed formularies, selective susceptibility reporting, educational sessions, and restriction of pharmaceutical promotional activities.