There is a worldwide movement to control the usage of drugs (antibiotics) through the practice of evidence based medicine and implementation of following measures:
1. Formulating and implementing a Rational Antibiotic Policy evolved through consultations among the clinicians and in accordance with the latest norms in practice, all over the world.
Responsibility for framing the policy may be entrusted to the Infection Control Committee. Drugs and Therapeutics Committee may be made responsible for its implementation.
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2. The antibiotic policy should cover all aspects of antibiotic usage in all departments of the hospital such as outlined below:
a. General guidelines about the antibiotic usage such as:
i. Before starting the antibiotic the physician must think whether the patient actually requires the antibiotic. There should be sufficient basis for starting the antibiotic.
ii. Broad-spectrum antibiotics should be prescribed only where fully justified.
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iii. When there is more than one option that is equally effective, as a policy, the least costly antibiotic may be selected.
iv. There is no need of changing the antibiotic if the clinical condition is improving.
v. If there is no clinical improvement within 72 hours, the diagnosis or the choice of antibiotic may be reviewed or the possibility of a secondary infection may be considered.
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vi. Duration (minimum and maximum) of antibiotic therapy must be standardized. As a policy, continuation after the full course (5 days) may be only after review of the condition and with full justification.
vii. For prophylaxis such as in surgical cases, standardized regimes may be followed with the specified minimum duration, dosage, route and timing of administration.
viii.Colonized patients (who are not actually infected) do not require any antibiotics.
b. Issue of guidelines for prescribing antibiotics including indications for starting prophylactic, empirical and therapeutic regimes, the optimum dosage, timings, and duration of usage.
c. Guidelines about when to prescribe the latest antibiotics (such as 3rd/4th/5th generation Cephalosporins).
d. Guidelines about dosage in case of children and patients with renal problems.
e. Guidelines about usage of antibiotics during pregnancy and lactation.
f. A procedure for reporting to the Infection Control Committee, whenever antibiotic resistance is suspected by the treating physician so as to analyze and confirm the occurrence of drug resistance.
g. All cases of unusually long stay, complications or unexpected results may be analyzed to rule out the possibility of antibiotic resistance.
h. There should be a targeted action plan in the areas where specific problems are detected related to high incidence of HAI and/or drug resistance or prescription pattern in persistent violation of the antibiotic policy laid down.
It may also lead to education of the concerned clinicians with a view to influence them to follow the antibiotic policy in letter and spirit.
3. Restriction on antibiotic usage curbs professional independence and is likely to create conflict. It is never desirable and should be imposed only in extreme situations, where other means have failed and the problem of antibiotic resistance and high HAI are getting out of control.
A better approach may be to allow the clinicians to prescribe the second orthird line drugs only after consulting their peer group and recording the justification/ reasons in the case records.
4. A pocket sized hospital formulary including all essential information about the drugs, their usage, prescription, side effects and prices can be useful to the clinicians for quick reference, when required.
It may also include guidelines on the selection of antibiotics for empirical and targeted therapy of major infections as well as the first and second line therapy of common infections.
5. Antibiotic policy must promote evidence based (rational) usage of antibiotics. For instance, the common practice of empirically administering antibiotics (especially broad-spectrum) in cases of common cold, flu, etc (viral problems) does not have any justification and must be discouraged.