Project «Antibiotic Policy in Surgery 2003»
I. Antibiotic Policy in Surgery
Antibiotic policy reviews general issues concerning use of antimicrobials in surgery rather than particular points of antimicrobial prophylaxis and treatment of given surgical infection. Ever-increasing opportunities for use of antimicrobials in surgical infection face to serious problem. The most important problem is inappropriate use of antibiotics, which leads to the emergence of antimicrobial resistance.
Since antimicrobial agents are used more intensively in hospitals, implementation of antibiotic policy in hospitals should contain resistance.
Implementation of antibiotic policy is national task and requires governmental and financial support. However, improving quality of medical care of patients, reducing the cost of treatment, and preventing the emergence of multi-resistant microorganisms are benefits for national health and budget.
An antibiotic policy should:
- Improve patient care by considered use of antibiotics for prophylaxis and therapy;
- Contain the emergence of multiple antibiotic-resistant bacteria;
- Improve education of medical stuff by providing guidelines for appropriate therapy;
- Make better use of finances.
Implementation of antibiotic policy
A national expert committee on antibiotic policy should be established. This committee should develop guidelines for creating and auditing rational antibiotic policies. In turn, each health-care institution should have a therapeutics committee to develop a local antibiotic policy based on national recommendations.
For implementation of local antibiotic policy such division as «antimicrobial agents team» (hospital antibiotic policy group) should be organized. An antibiotic subcommittee within a hospital drug or infection control committee or an antibiotic committee should be responsible for the formulation and supervision of an antibiotic policy.
The main tasks of hospital antibiotic policy group are the following:
- Development/updating of hospital formulary for antimicrobials (after full consultation with the clinical staff);
- Development/updating of guidelines for prophylaxis and empiric/directed therapy of infection and dissemination to hospital physicians;
- Development, implementation and evaluation of initiatives to curtail excessive antimicrobial consumption, through
- assessment of appropriateness of indications
- limitation of use of broad-spectrum antibiotics
- limitation of length of antimicrobial therapy/prophylaxis.
- Organization of permanent training activities in the hospital towards medical/paramedical personnel from diagnosis to treatment, control of resistance and costs of antimicrobial treatment;
- Quality assessment and reporting;
- Laboratory based surveillance of resistance;
- Pharmacy-based surveillance of antimicrobial consumption per hospital service/individual physician and reporting to hospital authorities;
- Cooperation between clinical pharmacist and infection control team.
Membership of an antibiotic committee may vary according to local conditions and needs. Antimicrobial agents team may consist of a clinical pharmacist, clinical microbiologist, clinical epidemiologist (or members of infection control team) and clinical doctors and nurses (will link between clinical practice and the antibiotic committee).
Antimicrobial part of drug formulary
Hospital-specific antibiotics lists constitute an important tool for optimizing the use of antibiotics in hospitals. Every hospital should compile its specific antibiotics list as a part of drug formulary. This list should contain information on the antibiotics (active substances and trade names) to be used in the relevant hospital. A distinction may be made between standard and reserve antibiotics. For every antibiotic, the standard dosage and the daily therapy costs can be specified.
The lists must be updated regularly in accordance with the prevailing resistance and market situation.
The decision of which antibiotic would be the most suitable rests with the treating physician.