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Antimicrobial stewardship (AMS) is the systematic effort to educate and persuade prescribers of antimicrobials to follow evidence-based prescribing, in order to stem antibiotic overuse, and thus antimicrobial resistance.
It is estimated that, in the UK alone at least 2,000 people a year are known to die from an antibiotic-resistant infection. The true figure is much higher as "antibiotic resistance" rarely appears on the death certificate.
Worldwide, 1.2 million die directly every year, and a further 5 million from illnesses in which AMR played a role.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02724-0/fulltext
AMS was started by specialist physicians and paediatricians in infectious diseases in the late 1990s. They have involved their respective peer-organisations, hospital pharmacists, the public health community and their professional organisations.
AMS has largely been voluntary self-regulation in the form of policies and appeals to prescribers to be self-disciplined. At hospitals, this may take the form of an antimicrobial stewardship program.
At the level of the individual dental practice, AMS will be less process-led. It requires a leader with belief and vision, who is prepared to seek the evidence for when antibiotics should be prescribed (for example by studying this Dentaljuce module), and push it through their dental practice. This is a positive step from continuing to prescribe as one has always done.
What problems might less AB prescribing cause?
It can cause dissatisfaction from patients who may be used to (and prefer) being given antibiotics to control toothache or bleeding gums, rather than having immediate operative intervention.
It can cause dissatisfaction and stress in colleagues who have previously used antibiotics as a way of "getting rid" of an emergency patient when there is no available time for operative work.
It might be hard to explain to patients why you have changed your operating practice "for the greater good", when they are most interested in their personal good.
AMS is a set of coordinated strategies to improve the use of antimicrobial medications with the goal to
enhance patient health outcomes,
reduce antibiotic resistance,
decrease unnecessary costs.
Decreasing the overuse of antimicrobials is expected to serve the following goals:
improve patient outcomes, especially patient safety
decrease adverse drug reactions such as hypersensitivity reactions or kidney or heart damage (e.g., QT prolongation).
decrease antibiotic-associated disease, such as Clostridium difficile–associated diarrhoea, other antibiotic-associated diarrhoeas, and invasive candidiasis
guard the patient's microbiome, including the gut flora, respiratory tract flora, urogenital tract flora, and skin flora (this is closely related to the preceding goal of preventing antibiotic-associated disease)
decrease wasted costs
slow the increase in antimicrobial resistance
Decreased use will also reduce environmental degradation, such as the adverse effects of altering plant and animal microbiotas by polluting the water cycle with antimicrobials in wastewater. Three quarters of an antibiotic dose in a human or animal is not absorbed, and comes straight out again, usually ending up in the water table.
Another huge concern is antibiotics coming out of cost-conscious pharma factories straight into the environment, due to poor or completely absent filtration of their waste liquids.
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Key Points
Please take a moment to review these points, reflect on their significance and consider how they apply to your own experiences.
Tick to confirm (optional):
Antimicrobial stewardship (AMS) aims to reduce antibiotic overuse and combat antimicrobial resistance.
In the UK, at least 2,000 people die annually from antibiotic-resistant infections, with global deaths at 1.2 million directly linked to AMR.
AMS encourages evidence-based prescribing to improve patient outcomes and reduce adverse drug reactions.
Reducing antibiotic use protects the patient’s microbiome and decreases environmental impact from antimicrobial pollution.
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