Hospital Antibiotic Policy

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SEA-HLM-414
Distribution: General

Step-by-step approach for
development and implementation of

hospital antibiotic policy
and

standard treatment guidelines

© World Health Organization 2011
All rights reserved. Requests for publications, or for permission to reproduce or translate WHO publications, whether for sale or for noncommercial distribution, can be obtained from Publishing and Sales, World Health Organization, Regional Office for South-East Asia, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi-110 002, India (fax: +91-11-23370197; e-mail: publications@ searo.who.int).

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. This publication contains the collective views of an international group of experts and does not necessarily represent the decisions or the stated policy of the World Health Organization. Printed in India

iii

Contents
iv

1.

Introduction

1

2.

Antibiotic policy

6

3.

Surveillance of antimicrobial resistance

13

4.

Cumulative antibiogram

18

5.

Development of standard treatment guidelines

21

6.

Strategies for promoting rational antibiotic prescribing

26

7.

A model standard treatment guideline
for community-acquired pneumonia at the hospital level

30

8.

Antimicrobial stewardship

35

9.

Further reading

39

Annexes
1.

Contributors

42

2.

Technical resources

43

Step-by-step approach for development and implementation of hospital antibiotic policy and standard treatment guidelines

List of abbreviations

Step-by-step approach for development and implementation of hospital antibiotic policy and standard treatment guidelines

List of abbreviations
ABC Calc

antibiotic consumption calculator

AMR

antimicrobial resistance

AMT

antimicrobial team

ARIMA

auto-regressive integrated moving average

ATC

anatomic therapeutic chemical

ATS

American Thoracic Society

BSAC

British Society for Antimicrobial Chemotherapy

CAP

community-acquired pneumonia

CDC

Centers for Disease Control and Prevention (Atlanta)

CLSI

Clinical and Laboratory Standards Institute

CWA

community-wide antibiograms

DDD

defined daily dose

EPOC

effective practice and organization of care

EQAS

External Quality Assessment Scheme

EUCAST

European Committee on Antimicrobial Susceptibility Testing

HAI

health-care associated infection

ICU

intensive care unit

IDSA

Infectious Diseases Society of America

KPC

Klebsiella pneumoniae carbapenemase

MIC

minimum inhibitory concentration

MRSA

methicillin-resistant Staph aureus

NABH

National Accreditation Board for Hospitals

NABL

prescribed daily doses

SCA

Science Computing Associates

SHEA

Society for Healthcare Epidemiology...
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