Antimicrobial stewardship to optimize antimicrobial use

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Antimicrobials can be viewed as double edged sword. Their life saving benefits and disease modifying effects are widely known and appreciated. However, the opposing edge of the sword can be just as sharp, which can cause serious patient harm in the form of adverse drug events and emergence of resistance. While the adverse events can occur during therapy and are more tangible to the practicing clinicians, the emergence of resistance often occurs late and is less obvious. In 1956, a noted microbiologist Ernest Jawetz once wrote, “On the whole, the position of antimicrobial agents in medical therapy is highly satisfactory. The majority of bacterial infections can be cured simply, effectively and cheaply. The mortality and morbidity from bacterial diseases has fallen so low that they are no longer among the important unsolved problems in modern medicine(1).”In the current antimicrobial era some 50 plus years, after these optimistic observations were made, shows an increase in number of infections that are difficult to treat, leading to an increase in morbidity and mortality. Studies have shown a strong relationship between antibiotic use and selection of resistance in humans. Controlled studies have also shown in which patients with prior use of antimicrobials were more likely to be colonized or infected with resistant bacteria. A number of infectious diseases remain as unsolved problems in modern medicine. This has become a challenge to many clinicians calling attention to the abuse of antibiotics and its results(2,3)