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Table 3 Actions and recommendations to improve rational antibiotic use

From: Encouraging rational antibiotic use in childhood pneumonia: a focus on Vietnam and the Western Pacific Region

Actions Suggested high-level recommendationsa
In general
Enhanced regulation • Limit over-the-counter availability of antibiotics; establish strong national policies for appropriate antibiotic regulation; implement measures to ensure compliance
• Improved national surveillance of antimicrobial resistance and adherence to treatment guidelines
• Regulate agricultural use of antibiotics
Patient/public education • Increase general awareness of adverse effects associated with excessive antibiotic use
• Educate parents, caretakers, politicians and the general community about the benefits of restricted antibiotic use
Universal Hib and PCV • Make Hib and PCV universally available free of charge
• Maintain high uptake of other vaccines (e.g. pertussis and measles)
Within hospitals
Provide information on local drug resistance patterns • Maintain a network of functional microbiology laboratories, with adequate quality assurance and sharing of information
Establish functional antimicrobial stewardship programs • Each hospital should have an antimicrobial stewardship program and a Drug and Therapeutics Committee with access to reliable and up-to-date data on antibiotic usage and drug resistance profiles
• Each hospital should have regular/annual antibiotic use audits led by pharmacists or infectious disease control personnel
Provide clear guidance • Develop national/regional consensus treatment guidelines that consider the international evidence base, as well as local disease etiology and drug resistance data
Eliminate perverse incentives • Delink remuneration from antibiotic prescription
• Ban incentives to doctors to provide antibiotics or use specific medical products
Educate medical students and trainees • Include antimicrobial stewardship in the undergraduate medical, nursing and pharmacy curriculum
• Highlight the growing drug resistance problem and need for prudent use
  1. PCV pneumococcal conjugate vaccine, Hib Haemophilus influenzae type b
  2. aIn addition, a detailed assessment of pneumonia case management should be conducted to understand clinical decision-making and provide more pragmatic guidance to clinicians in the field. Exemplars of comprehensive national strategies to address antimicrobial resistance and limit excessive antibiotic use include the United Kingdom, the United States and Australia [67,68,69]