Antibiotic stewardship: A review of successful, evidence-based primary care strategies

BACKGROUND: Antibiotic resistance is a rising global threat with only two options for mitigation: 1) invent new antibiotics and/or 2) use current antibiotics more wisely. In Australia, the majority of antibiotic usage is in the community, hence primary care has a key role. OBJECTIVE: With no single 'magic bullet', a range of approaches is needed. The aim of this article is to describe the options and evidence in three broad categories: 1) regulatory changes such as repeats and pack sizes, 2) policy initiatives such as public campaigns, academic detailing and education and 3) clinical strategies including delayed prescribing, clinical decision support tools, practice-based audit and feedback, and patient information sheets.

DISCUSSION: Australia has good antibiotic regulation and guidelines but must invest in sustained primary care stewardship programs, which should include surveillance, information for consumers, support for general practitioners and general practice training, and an ongoing evaluation and research program.