Antimicrobial Stewardship
Antimicrobial stewardship refers to a systematic approach to optimising the appropriate use of an antibiotic to improve patient outcome(s) and limit emergence of resistant pathogens, whilst ensuring patient safety. It is one arm of the national and international response to the increasing public health crisis of antibiotic resistance. A critical component is adequate infection control. Antibiotic
Antimicrobial stewardship refers to a systematic approach to optimising the appropriate use of an antibiotic to improve patient outcome(s) and limit emergence of resistant pathogens, whilst ensuring patient safety. It is one arm of the national and international response to the increasing public health crisis of antibiotic resistance. A critical component is adequate infection control. Antibiotics should only be used for the treatment and prevention of bacterial infections. The following checklist will help optimise prescribing:
| Checklist for optimal antibiotic prescribing |
| 1. Medicine – which is the narrowest-spectrum antibiotic that I can use to treat this bacterial infection? |
| 2. Dose – many antibiotics require weight-based dosing and their dosing depends on renal and/or hepatic function. |
| 3. Dose frequency – dependent on the half-life of the drug and whether the activity of the antibiotic depends on the time above the MIC, the peak concentration relative to MIC, or the area under the concentration/time curve. Guidance for dosing frequency may require therapeutic drug monitoring, e.g. vancomycin and aminoglycosides. |
| 4. Duration – should be dictated by evidence from randomised controlled trials whenever possible. Expert opinion from national and international guidelines should be consulted where evidence is weak. |
| 5. Route – most antibiotics have good oral bioavailability, but some infections will require intravenous therapy either for the whole or part of the course. Patients who are critically ill, or who would be expected to have impaired gastrointestinal absorption of medicines (e.g. excessive vomiting) may also require intravenous antibiotics initially. |
| 6. De-escalation – applies to the spectrum of antibiotic use and route of administration. All attempts to convert early from parenteral to oral use should be made. |
| MIC = minimum inhibitory concentration. Further guidance on local antimicrobial stewardship can be found online: https://knowledgehub.health.gov.za/content/antimicrobial-resistance |
Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 1.2_20 January 2025
Chapter 9: Systemic and Healthcare-Associated Infections_ Antimicrobial Stewardship