The Ten Commandments of Antibiotic Stewards

Abstract

Antibiotic resistance is an emergency for global health security, the solution for which demands a transdisciplinary and interprofessional One Health approach. This case study builds on a project to recruit antibiotic stewards and examines their responsibility to disseminate best practices, to support deeper knowledge, conservative attitudes and preventive practices. Antibiotic resistance is a global emergency that threatens the reversal of improvements in societal capacity to reduce human mortality caused by infectious pathogenic bacteria. Solutions to the problem demand a One Health approach because antibiotics are abused in animal and human healthcare; and the emergence and spread of resistant pathogens occurs in environmental contexts. In all regions of the world, antibiotic resistance increases the global burden of diseases by jeopardizing population health, food security and environmental quality, with most of the adverse impacts expected in Africa. Proposed remediation strategies hinge on improving antibiotic stewardship through deeper knowledge of social and ecological determinants of resistance, conservative attitudes in antibiotic uses, and preventive practices to curb infectious diseases. This case study is based on a project entitled Antibiotic Stewardship is Public Health (ASPH), with the goal of empowering stewards with tools to implement strategies for preventing antibiotic-resistant infections. The Ten Commandments of antibiotic stewards emerged from population surveys, stakeholder interviews and community engagement exercises. Outcomes were distilled to inform best practices including: using antibiotics as prescribed; not disposing of expired antibiotics in domestic waste; advocating prudent use of antibiotics in farm animals; supporting research to respond better to antibiotic resistance; teaching students about the importance of antibiotics for global health security; understanding the One Health approach to combatting antibiotic resistance; advocating effective policies to stop the careless use and disposal of antibiotics; resisting consumption of food items laden with antibiotic residues; and supporting research to discover alternative therapies to prevent or treat infections.