Antibiotic stewardship initiatives in healthcare settings aim to promote the judicious use of antibiotics. They are a critical element in stemming the global threat of antibiotic resistance. Stewardship programs are credited with reducing the use of unnecessary antibiotics, creating education around the appropriate use of antibiotics and changing provider behavior around prescribing. All of these factors have resulted in improved patient outcomes and decreased costs. Progress is being made, but in order to continue advancing the field of antibiotic stewardship, it is imperative to identify important research and implementation questions and execute studies and interventions to inform best practice.
Researching in several areas
There are several categories of research that inform antibiotic stewardship. First, research is needed to inform the most effective approaches for performing stewardship. For example, does up-front restriction of certain antibiotics improve how they are used in a hospital versus following up on their use after they are prescribed? Does implementation of rapid diagnostic tests, that allow for earlier microbiologic diagnosis, improve patient outcomes?
Studies that provide more data on the best ways to treat infectious syndromes are important to better inform how we use antibiotics. As an example, this kind of study might ask, what is the shortest duration of antibiotic therapy that is effective for common infections such as pneumonia and urinary tract infections?
Qualitative research that helps identify behaviors around antibiotic prescribing and how to modify these behaviors is crucial for long-term change. For example, why do clinicians prescribe antibiotics for patients with viral infections even though guidelines recommend against this practice? What are the best strategies to modify this behavior?
We also need to identify and implement more actionable and reproducible metrics to assess the degree to which guidelines are followed. Perhaps, for example, we can identify ways to measure antibiotic use using electronic data that allows us to adjust for the comorbidities and illness severity of a patient population.
Prescribing more effectively
Research enables all healthcare providers to better understand how stewardship initiatives are impacting patient care and how they can improve their own prescribing. It will enable the development of new, creative and streamlined strategies to make it easier for providers to prescribe antibiotics more judiciously. Stewardship initiatives are one of the most powerful and immediate tools we have in the fight against antibiotic resistance. They dramatically impact patient care for the better. For these programs to remain effective and to grow, we must make research a priority. It is the only way we can better understand what works and what does not work. It is also a critical component to preserving antibiotics as the precious resource that they are for healthcare.
