The member of a cabin crew in an airplane, a hotel steward, or an estate steward, which of them comes to your mind when you hear the word steward? Well, stewardship can be done in any field. In the field of medicine, every medical practitioner can become a steward. Becoming a steward for antimicrobials can be very rewarding for oneself as well as the community at large. Let me quote here the wise and arguably prophetic words of Alexander Fleming from his Nobel Lecture on December 11 1945, “The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”
The pandemic of antimicrobial resistance is alarming in the present day, and organisations world over are taking or planning to take adequate steps to curtail it, antimicrobial stewardship program being the most important among them.
The right diagnosis, the right drug in the right dose for the right duration and de-escalation of the antimicrobial therapy when appropriate form the five Ds of antimicrobial stewardship- the five pillars of success for an antimicrobial stewardship(AMS) program. Culture review and follow-up, clinical decision support and education as well as periodic prospective audit and feedback are required to leverage various speciality departments of the hospital to comply with the stewardship interventions including pre-authorisation for restricted anti-microbials. A team involving an infectious diseases physician, a clinical microbiologist and a clinical pharmacist would work in co-ordination to run an AMS program. The team may have to persevere for years before the efforts come to fruition.
Depending on the geographical region, the challenges with regards to antibiotic resistance vary. In India where high end antibiotics are available over the counter and indiscriminate use of antibiotics continues amongst humans and animals, the necessity for antimicrobial stewardship cannot be over-emphasised.