Antibiotic stewardship is a public health effort to work with health providers to ensure the judicious use of antibiotics prescribing. The effort includes fine-tuning and targeting the prescribing of antibiotics to treat the correct infections (for example, not viral-caused diseases) with the lowest dosages for the lowest amount of time to reduce patient harms caused by unnecessary antibiotic use and slow the development of antibiotic resistance.
Deeper dive
About 30% of all antibiotics prescribed in U.S. acute care hospitals are unnecessary or inappropriate, the CDC estimates.
Overuse of antibiotics in hospital settings is one of the factors in the rise of “superbugs,” the term for bacteria that has become resistant to many if not all antibiotics. Inappropriate use of antibiotics has also caused some patients to develop serious side effects, like a hard-to-treat illness from clostridium difficile. C. diff is a bacterium that can live harmlessly in the gut, kept in check by healthy bacteria. But when a person gets too many antibiotics, healthy bacteria are killed off, enabling C. diff to flourish.
Antibiotic stewardship programs in hospitals aim to curb the inappropriate use of antibiotics to ensure that existing drugs remain effective, and patients don’t experience adverse events.
Over the past decade, the CDC has been publishing infection control and antibiotic stewardship guidelines for hospitals to follow. See the CDC’s core elements of hospital antibiotic resistance stewardship programs as of 2021 here.
Generally, stewardship programs include support for physicians to help them determine whether a patient really needs an antibiotic and what type of antibiotic would be most appropriate. Support includes providing physicians with rapid diagnostic testing to determine if a patient is sick with a bacteria or virus [viruses cannot be treated with antibiotics] and determine the type of bacteria making a patient ill. Once the bacteria is diagnosed, the hospital then can help the physician determine the best antibiotic to treat the patient. To do so, a hospital program might assign one hospital pharmacist with a specialty in antibiotics, to work with the physician. See the CDC’s guidelines here.
Culturally, hospital doctors tend to prescribe an antibiotic to a patient, even if they don’t know what is wrong with the person, out of an abundance of caution. Often physicians will also give patients a broad-spectrum antibiotic. Broad-spectrum means a type of antibiotic that kills all kinds of bacteria. The problem is that these medications will also kill healthy bacteria that a patient needs to stay well, and a narrow antibiotic might have been better suited for the patient.