Table 3 Actions and recommendations to improve rational antibiotic use
| 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 |