Antibiotic use in office practice - 50% is inappropriate; 30% or more is unindicated.
Goals of antibiotic stewardship – Maximize treatment benefit; Minimize harm to patients and community.
Appropriate antibiotic prescribing: Right antibiotic for, Right patient (indication) in the, Right dose through, Right route for, Right duration.
Core elements of outpatient antibiotic stewardship: Commitment – clinicians/facility leader: Be the antibiotic steward; display statement supporting antibiotic stewardship in the clinic waiting area; identify a single leader to promote antibiotic stewardship. Action for policy and practice – Use of evidence-based diagnostic criteria and treatment recommendations; provide communication skills to the clinician; written justification for use of antibiotic; provide support for clinician decision. Tracking and reporting antibiotic use - There is a need to self evaluate. Education and expertise of patients and clinicians – Provide educational resources and expertise; use of smartphone apps; review guidelines; educate the patients and family members.
Steps – Identifying high-priority conditions; identifying barriers to improving antibiotic prescribing; establishing standards for antibiotic prescribing.
Overcoming barriers: Clinician knowledge gaps about best practices and clinical practice guidelines → Education through CME, Workshops, mobile apps; Clinician perception of patient expectations for antibiotics → Educate patients; Perceived pressure to see patients quickly → Restrict and discipline; Clinician concerns about decreased patient satisfaction with clinical visits when antibiotics are not prescribed → Counselling and confidence, communication skills.
Improving antibiotic prescribing: Use Rapid tests and international, facility-specific, local epidemiology-based guidelines.
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