What can you do to keep antibiotics working?

Everyone is responsible. Below you will find a few examples of actions by which you can contribute to keep antibiotics working:

Everybody (patients, parents, etc.) can contribute to keep antibiotics working by:

  • Using antibiotics only against bacterial infections, and not infections caused by viruses such as common colds or flu.
  • Always seeking a doctor’s advice before taking antibiotics.
  • Once the doctor has confirmed that antibiotics are necessary, taking them in a responsible manner, following the doctor’s advice in terms of dosage and duration of time.
  • Avoiding self-medication with antibiotics. Self-medication is when you use leftover antibiotics from previous treatments, or get antibiotics at the pharmacy without a prescription.
  • Not sharing left-over antibiotics with other people.
  • Not keeping leftover antibiotic treatments. If you received more antibiotic doses (e.g. tablets, gel caps) than you were prescribed, ask your pharmacists about how to dispose the remaining doses.
  • Learning how you can take care of yourself without antibiotics, if they are not necessary.
  • For winter-related illnesses, drinking plenty of fluids and getting some rest to help improve your symptoms.

Primary care prescribers can contribute to keep antibiotics working by:

  • Prescribing antibiotics responsibly, as primary care accounts for about 80% to 90% of all antibiotic prescriptions, mainly for respiratory tract infections.
  • Avoiding unnecessary antibiotic prescriptions. There is evidence showing that, in many cases of respiratory tract infections, antibiotics are not necessary, and the patient’s immune system is competent enough to fight simple infections.
  • Communicating effectively with patients and impacting their perceptions and attitudes towards their illness and perceived needs for antibiotics.

Policy makers can contribute to keep antibiotics working by:

  • Creating a national multidisciplinary taskforce made up of experts in the field with political support is essential. This taskforce will create policy, collect data and intervene when necessary at the national and hospital level.
  • Ensuring that hospitals have an adequate ratio of appropriately trained infection control practitioners (ICPs) to beds. A ratio of 1 ICP per 250 beds has been the standard; newer evidence may support a ratio of 1 ICP per 100 beds.
  • Facilitating the implementation of active screening of ‘at-risk’ patients upon admission to a hospital, as an effective method to detect whether patients are carrying highly resistant bacteria.
  • Ensuring that measures for isolation of patients who are carriers of highly resistant bacteria, ideally in single rooms or alternatively in separate areas such as ‘cohort wards’ are in place, as this is an important measure to contain the spread of these bacteria.
  • Promoting hand hygiene as the single most important measure to prevent transmission of bacteria in hospitals, as the cost of hand hygiene promotion is less than 1% of the cost of taking care of patients with healthcare-associated infections.

Pharmacists can contribute to keep antibiotics working by:

  • Advising patients on minor ailments and referring them when required to their doctor.
  • Demystifying the need to use antibiotics to treat flu, colds and other minor ailments.
  • Advising on how to use antibiotics prudently.
  • Managing pharmacy-based medicines waste collection services, which contribute to the reduction of available antibiotics in households.
  • Participating in/developing prudent antibiotic use campaigns at national and European level.

Hospital prescribers can contribute to keep antibiotics working by:

  • Following antibiotic treatment protocols, based on evidence-based guidelines, and apply infection prevention and control measures that are established in your setting.
  • Consulting the antibiotic stewardship team when needed, for examples when you prescribe an antibiotic outside of normal guidelines.
  • Only starting antibiotic treatment if there is evidence of a bacterial infection, and do not treat colonisation.
  • Avoiding unnecessary antibiotic prophylaxis.
  • Documenting the indication of antibiotic treatment, drug choice, dose, route of administration and duration of treatment in the patient chart.
  • Being a good source of information for your patients and help them understand the importance of prudent antibiotic use. Ensuring that patients (and their families) understand the reasons for antibiotic therapy, and key points related to antibiotic use.
  • For patients with severe infections, initiating effective antibiotic treatment as soon as possible.
  • Regularly participating in training courses and in meetings that support the implementation in the hospital of: a) prudent antibiotic use, b) evidence-based, local antibiotic guidelines, and c) infection prevention and control measures.

Hospital managers/administrators can contribute to keep antibiotics working by:

  • Supporting your multidisciplinary antibiotic stewardship team by designating the specific leaders for accountability and drug expertise, and by stating the supportive roles of other key groups.
  • Prioritising antibiotic stewardship and infection prevention and control policies, as well as strategies and activities that support prudent antibiotic use and prevent the spread of antibiotic-resistant bacteria.
  • Providing funds and resources for an antibiotic stewardship programme (including e.g., salaries for dedicated staff, IT capabilities, rapid and point-of-care diagnostic tests).
  • Funding and promoting educational activities, training, and meetings about antibiotic stewardship and antibiotic resistance for all healthcare professionals (physicians, infectious disease specialists, pharmacists, microbiologists and nursing staff).
  • Strengthening surveillance activities for antibiotic use and antibiotic resistance.
  • Promoting compliance with evidence-based guidelines for diagnosing and managing common infections, and for perioperative antibiotic prophylaxis. If these guidelines do not exist in your hospital, then support their development.
  • Promoting using local microbiology and antibiotic resistance patterns to inform guidelines and empirical antibiotic choices.
  • Promoting compliance with evidence-based guidelines for infection control measures, to reduce transmission of antibiotic-resistant bacteria.
  • Promoting proactive audits and ensure that individual prescribers receive feedback.
  • Promoting peer-review of antibiotic prescriptions and infection management, and encourage communication among healthcare professionals.

Infectious disease specialists can contribute to keep antibiotics working by:

  • Supporting the development and implementation of an antibiotic stewardship programme within your organisation.
  • Promoting local guidelines on managing infections and using antibiotics. These should be readily and reliably accessible to all healthcare providers.
  • Checking protocols, based on evidence-based guidelines.
  • Providing feedback and advice to prescribers on diagnostic evaluation and treatment of infectious diseases.
  • Regularly training hospital prescribers on prudent antibiotic use and participate in meetings on implementing evidence-based hospital antibiotic guidelines.

Infection prevention and control and hospital epidemiologists can keep antibiotics working by:

  • Making guidance for infection prevention and control measures to reduce healthcare-associated infections and transmission of microorganisms readily and reliably accessible. This guidance can include guidelines, protocols and checklists.
  • Organising and promoting educational events, courses and meetings together with hospital administrators to strengthen infection prevention and control activities among all healthcare professionals (e.g. hand hygiene, contact precautions, active screening cultures, and environmental cleaning).
  • Coordinating hospital surveillance of healthcare-associated infection through using both:
    • Point prevalence surveys, which give a snapshot picture of the number of patients with healthcare-associated infection in hospital at a particular point in time, and
    • Long-term surveillance of the incidence of healthcare-associated infections (e.g. in intensive care units, or for specific infection types).
  • Using local data on healthcare-associated infections, set local targets and find areas where additional infection prevention and control support is needed.
  • Monitoring how effective targeted preventive measures are at reducing transmission of antibiotic-resistant bacteria.
  • Training healthcare professionals regularly on how to implement effective prevention and control strategies.

Hospital pharmacists can contribute to keep antibiotics working by:

  • Supporting the development and implementation of an antibiotic stewardship programme within your organisation.
  • Providing feedback and advice to prescribers on antibiotic choice, dose, duration optimisation and route of administration.
  • Encouraging clinicians to perform appropriately timed parenteral-to-oral switches.
  • Checking that antibiotic prescriptions follow antibiotic treatment protocols, based on evidence-based guidelines.
  • Collecting and sharing data on antibiotic use and costs at ward level and hospital level.
  • Together with prescribers, providing patients who have to continue antibiotic therapy after discharge with information on use of antibiotics at home.
  • Training hospital prescribers regularly on prudent antibiotic use and participate in meetings on implementing evidence-based hospital antibiotic guidelines.

Hospital nurses can contribute to keep antibiotics working by:

  • Improving antibiotic administration practices in collaboration with doctors and pharmacist.
  • Following infection prevention and control measures that are established in your setting.
  • Ensuring that patients (and their families) understand the reason for antibiotic therapy, and key points related to antibiotic use.
  • Ensuring that cultures are appropriately taken and send to the microbiology laboratory, before starting antibiotics.
  • Ensuring that laboratory results are promptly communicated to the treating physician.
  • Prompting prescribers to document their reviewing decision for all patients on antibiotics after 48-72 hours.
  • Informing the prescriber or pharmacist if you see a patient has an antibiotic prescription which has continued beyond seven days without specified duration.
  • Participating regularly in training courses and meetings on prudent antibiotic use, specimen collection, and infection prevention and control.

Microbiologists can contribute to keep antibiotics working by:

  • Providing guidelines for specimen collection, storage and transport.
  • Ensuring that laboratory testing and antimicrobial susceptibility reporting follow treatment guidelines (including selective reporting), and include relevant comments on interpretation if needed.
  • Ensuring that identification and antimicrobial susceptibility testing results are communicated to prescribers, nurses and the antibiotic stewardship team, especially for critical results (e.g. blood cultures).
  • Ensuring that testing and reporting of microbiology results follow European and national standards (i.e. European Committee on Antimicrobial Susceptibility Testing - EUCAST).
  • Providing data on antibiotic resistance at hospital level and ward level, and communicate trends to the antibiotic stewardship team and the infection prevention and control team.
  • Training hospital prescribers regularly on antibiotic resistance, and on use of rapid and point-of-care diagnostic tests.

Staff in emergency departments can contribute to keep antibiotics working by:

  • Following antibiotic treatment protocols, based on evidence-based guidelines (e.g. for sepsis, urinary tract infections, skin and soft tissue infections), and apply infection prevention and control measures that are established in your setting.
  • Taking a thorough patient history when you prescribe an antibiotic, including recent antibiotic use, drug allergies, use of immunosuppressive therapy, and risk factors for antibiotic resistance (for example, recent hospitalisation, recent procedure or recent travel outside of Europe).
  • Remaining aware of local antibiotic resistance patterns in the community, hospital and department.
  • Only starting antibiotic treatment if there is evidence of a bacterial infection, and do not treat colonisation.
  • Avoiding unnecessary antibiotic prophylaxis.
  • For patients with a severe infection, initiating effective antibiotic treatment as soon as possible.
  • Ensuring that cultures are taken before starting antibiotics.
  • Documenting the indication of antibiotic treatment, drug choice, dose, route of administration and duration of treatment in the patient chart.
  • Regularly participating in training courses and in meetings that support the implementation in the hospital of: a) prudent antibiotic use, b) evidence-based, local antibiotic guidelines, and c) infection prevention and control measures.

Staff in intensive care units can contribute to keep antibiotics working by:

  • Implementing guidance (guidelines, protocols and checklists) for infection prevention and control measures, together with the infection prevention and control team.
  • Following antibiotic treatment protocols, based on evidence-based guidelines that are established in your setting.
  • Only starting antibiotic treatment if there is evidence of a bacterial infection, and not treating colonisation.
  • Avoiding unnecessary antibiotic prophylaxis.
  • Taking a thorough patient history when prescribing an antibiotic, including recent antibiotic use, drug allergies, use of immunosuppressive therapy, and risk factors for antibiotic resistance (for example, recent hospitalisation, recent procedure or recent travel outside of Europe).
  • Documenting the indication of antibiotic treatment, drug choice, dose, route of administration and duration of treatment in the patient chart.
  • For patients with sepsis, initiating effective antibiotic treatment via the intravenous route as soon as possible.
  • Ensuring that cultures are appropriately taken and send to the microbiology laboratory, before starting antibiotics.
  • Regularly participating in training courses and in meetings that support the implementation in the hospital of: a) prudent antibiotic use, b) evidence-based, local antibiotic guidelines, and c) infection prevention and control measures.

Staff in long-term care facilities can contribute to keep antibiotics working by:

  • Implementing infection prevention and control measures together with infection prevention and control professionals.
  • Taking a thorough patient history when you prescribe an antibiotic, including recent antibiotic use, drug allergies, use of immunosuppressive therapy, and risk factors for antibiotic resistance (for example, recent hospitalisation, recent procedure or recent travel outside of Europe).
  • Always performing a clinical examination of the patient before prescribing an antibiotic.
  • Only starting antibiotic treatment if there is evidence of a bacterial infection, and not treating colonisation.
  • Avoiding unnecessary antibiotic prophylaxis (e.g. urinary tract infection prophylaxis).
  • Ensuring that cultures are taken before starting antibiotics.
  • Documenting the indication of antibiotic treatment, drug choice, dose, route of administration and duration of treatment in the patient chart.
  • Promoting vaccination programmes for residents and staff.
  • Following infection prevention and control measures that are already established in your setting.
  • Regularly participating in training courses and in meetings that support the implementation in the hospital of: a) prudent antibiotic use, b) evidence-based, local antibiotic guidelines, and c) infection prevention and control measures.
  • Organising educational events and campaigns that provide residents with information on prudent antibiotic use.
  • Ensuring that residents (and their families) understand the reasons for antibiotic therapy, and key points related to antibiotic use, including to:
    • Take antibiotics exactly as prescribed;
    • Never save antibiotics for later use;
    • Never use leftover antibiotics from previous treatments;
    • Never share leftover antibiotics with other residents or other people.
  • Regularly organising audits/surveys of antibiotic prescribing practices and of healthcare-associated infections.