Antibiotic stewardship: prescribing social norms
Lancet April 23, 2016 V.387 N.10029
Ian M Gould, Timothy Lawes
With a burgeoning world population, expansions in medical intervention, and intensified agriculture, the need for antibiotic stewardship is increasingly clear. Declining efficacy of antimicrobial prophylaxis for surgery or chemotherapy, and emergence of pan-resistant pathogens, warn of a post-antibiotic era. In the evolutionary arms race of antimicrobial resistance, rejuvenating the neglected pipeline for new agents provides only a partial solution. The key challenge worldwide is translating awareness of resistance into effective stewardship.
In the past decade, the UK has made notable progress. A high media profile has provided political leverage to advance antimicrobial resistance up national health agendas, and surveillance systems for antibiotic consumption and resistance have been established. National targets to reduce broad-spectrum antibiotic use have been associated with declines in Clostridium difficile and meticillin-resistant Staphylococcus aureus. However, declining sensitivities to substitute antibiotics4 suggest that without reducing total antibiotic consumption, we might be replacing rather than eliminating resistances. Sustaining progress will require a major shift in prescribing and consumption norms …