Abstract
Antimicrobial stewardship is the need of the hour to prevent the collapse of our health care system at the hands of a pandemic of resistant pathogens. Inappropriate and indiscriminate abuse of antibiotics has left very few options for prescribing physicians as most of the pathogens, particularly gram-negative, are resistant to the major antibiotics. This article reviews the importance of Antimicrobial Stewardship Programs (ASP) for internal medicine physicians and residents. Commonly encountered clinical scenarios are discussed. Appropriate indications of antibiotics, pathogen-guided prescriptions, adverse effects of common antibiotics, and options to use newer antibiotics are reviewed. The role of a health care team is highlighted. The evidence-based steps taken to ensure ASPs implementation are reiterated to serve as an educational guide for medical residents and physicians.
Highlights
BackgroundAntimicrobial resistance and need for antimicrobial stewardshipAntibiotics have achieved historical success against microbes since the discovery of penicillin
Infectious Diseases consultation should always be on board whenever resistant pathogens like Enterococcus faecium, S. aureus, Klebsiella pneumoniae, Acinetobacter species, Pseudomonas aeruginosa, Enterobacter are encountered for appropriate pathogen-directed therapy with minimal adverse events, resistance, and optimal clinical outcomes
If the Staphylococcus is not MRSA, clinicians should de-escalate the antibiotics to nafcillin or cefazolin to target methicillin-sensitive Staphylococcus aureus
Summary
Antibiotics have achieved historical success against microbes since the discovery of penicillin. Infectious Diseases consultation should always be on board whenever resistant pathogens like Enterococcus faecium, S. aureus, Klebsiella pneumoniae, Acinetobacter species, Pseudomonas aeruginosa, Enterobacter are encountered for appropriate pathogen-directed therapy with minimal adverse events, resistance, and optimal clinical outcomes. If the Staphylococcus is not MRSA, clinicians should de-escalate the antibiotics to nafcillin or cefazolin to target methicillin-sensitive Staphylococcus aureus This strategy prevents the unnecessary use of vancomycin and avoids its adverse effects. The role of internal medicine physicians and trainees should be to be mindful of unwarranted antibiotic exposure They should be able to identify the threat of C. difficile and effectively treat and prevent its potential outbreaks by following the general principles of antimicrobial stewardship. The health care team ensuring implementation of ASPs comprises Infectious Diseases consultants, resident and fellow physicians, hospital pharmacists, microbiology laboratory, infection control department (hand hygiene, contact precautions, bundles of care), and clinical pharmacists. The data from antibiograms can be construed to predict future outbreaks or improve pathogenload at the hospital level [23, 24]
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