Prescribing for change - safer antimicrobial use in hospitals

The World Health Organization (WHO) has stated that antimicrobial resistance is one of the greatest health threats facing humanity and is responsible for significant morbidity and mortality, with a disproportionate impact on vulnerable groups of patients. The WHO set out its global action plan in 2015 and most countries have their own national plans, which take a whole system One Health approach that includes infection prevention and optimising the use of antimicrobials through stewardship programmes and diagnostics. In hospitals, antimicrobials are some of the most commonly prescribed medications, creating significant selection pressure for emerging resistance. Antimicrobial stewardship (AMS) in hospitals comprises a set of structured interventions that seek to optimise the benefits of treatments while limiting the harms. AMS is effective and has proven benefits such as improved outcomes and reduced spread of resistance in hospitals. This paper highlights key principles for antimicrobial prescribing and highlights recent evidence, some of which has been practice changing.