Antimicrobial stewardship: Limits for implementation

Antibiotic stewardship programme (ASP) is a multifaceted approach to improve patients' clinical outcomes, prevent the emergence of antimicrobial resistance, and reduce hospital costs by prudent and focused antimicrobial use. Development of local treatment guidelines according to local ecology, rapid diagnostic in microbiology laboratory, dosage optimization following pharmacokinetic and pharmacodynamic profiles, formulary restriction for specific classes of antibiotics, appropriate duration of antibiotic treatment, ICU and wards specific antibiograms, programs of continuous education, feedback and prospective audit for healthcare workers, are fundamental components of an efficient ASP. Numerous studies have showed that it is possible to change antibiotic prescription attitudes in hospital, at different ecological, cultural and economical levels and ASP might play a significant role in the reduction of colonization and infections caused by antibioticresistant bacteria. Major risk in implementing ASP is the lack of consideration of local ecology and strict quality indicators. There is still an open debate over which outcomes to measure and the appropriate study design that can objectively assess ASP despite the limitations inherent in the structure of most such programs. European networks to define best strategies and antibiotic-care bundles need to be supported at national and international level.