This week, the World Health Assembly will meet to discuss – and likely pass—a global action plan on antimicrobial resistance. The action plan lays out five strategic objectives to promote better understanding of the threat of antimicrobial resistance, and to ensure the proper use and conservation of existing antimicrobials.
Antimicrobial stewardship, which comprises interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy, and route of administration, is a key component of the global action plan. Antimicrobial stewardship activities play an important role in the rational use of medicines, and help health professionals conserve our valuable antimicrobial resources.
SIAPS and predecessors have helped to implement stewardship activities in countries around the world through a number of means, including:
- Launching local advocacy initiatives for stewardship programs
- Developing and implementing standard treatment guidelines, formularies, and essential medicines lists
- Aiding in antimicrobial use evaluations
- Developing antimicrobial stewardship strategies and committees
- Revising pre-service curriculums and supporting in-service trainings for health services professionals to include components on antimicrobial resistance and rational medicine use
Case Study: Improving Antimicrobial Stewardship in Jordan
Work carried out in Jordan by SIAPS and its predecessor, the Strengthening Pharmaceutical Systems (SPS) project, demonstrates how antimicrobial stewardship activities can be promoted in local health facilities. Antibiotics used to prevent surgical infections account for as much as half of all antibiotics used in hospitals but are a frequent source of incorrect or inappropriate medicines use. A study conducted by the Jordan Food and Drug Administration (JFDA) in 2009* found that antimicrobials used for prophylaxis during common surgical procedures, like cesarean section, were frequently administered inconsistently or inappropriately. To help address this issue, SIAPS and its predecessor program SPS provided technical assistance to three hospitals in Jordan to strengthen antibiotic prophylaxis practices for cesarean section.
Working with a multidisciplinary team of stakeholders in each hospital, SIAPS helped collect baseline data and was able to make evidence-based recommendations for future procedures. The hospital stakeholders fully owned this initiative, spearheading the development of customized protocols and procedures for the prophylactic use of antibiotics. A cesarean section log, Excel monitoring tool, and indicators were established to help standardize the tracking of antibiotic prophylaxis practices in each facility.
Stakeholders from each facility worked together to identify gaps and improve processes—work that paid off in clear, measurable improvements. Results from all three hospitals show higher compliance with the new protocols and procedures as measured by the use of the preferred prophylactic antibiotic (cefazolin), the timing of administration, and the number of doses administered, as well as significant cost savings. Based on the experience from the three hospitals, the Ministry of Health developed, approved, and mandated in February 2013 a unified antibiotic prophylaxis protocol for cesarean section in all public, ministry-run hospitals.
Our work in Jordan shows that even small-scale interventions can lead to big results. In just a few years, the successful implementation of antimicrobial stewardship programs can reduce costs for health systems, save lives, and preserve the effectiveness of essential antimicrobials.
Authors: Mohan P. Joshi, Principal Technical Advisor and Cluster Lead for Pharmaceutical Services, and Elyse Franko-Filipasic, Senior Communications Associate