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Antimicrobial stewardship: challenges in India

Antimicrobial stewardship: challenges in India

For POLHN’s self-paced course, “Antimicrobial Stewardship Programmes in Hospitals”, students are required to complete a final assignment outlining some of their experiences. This week, one student –  Dr B. Ravichandran from India – shared some unique insights. His antimicrobial stewardship training and experiences make for an interesting and enlightening read!


I am working in a tertiary care hospital in India with one thousand beds, 5000 outpatients and 1000 inpatients per day. The hospital contains intensive care units, a specialised burns ward and plastic surgery ward, nephrology ward, a neonatal intensive care unit and OG department.

What does the AMS team look like at your hospital?

The AMS team in our hospital comprises of a chairman (head of the hospital), a secretary who is the clinical microbiologist and members, which include all the heads of medical (medicine, paediatrics, OG, nephrology, surgical departments, the chief pharmacist, the infection control officer and a chief nurse.

What are some challenges to the AMS team?

  1. Difficult to coordinate all the heads of medical and surgical specialists to participate in the stewardship programme, for example via monthly meetings.
  2. Noncompliance of the antibiotic restriction policy and de-escalation, switching from intravenous to oral, and antibiotic time out.
  3. There is no electronic health record system to collect and analyse the data of antibiotic usage, so it is difficult to determine local antibiotic susceptibility patterns.
  4. The Infection control practices – like hand hygiene, respiratory etiquette, use of personal protective equipment, cleaning and disinfection of hospital environment – should be meticulously followed by health care professionals and the paramedical staffs of the hospital.
  5. Monitoring and surveillance of the antimicrobial stewardship programme.
  6. Lack of support from the pharmacist to check the antibiotic use.
  7. Feedback from the respective departments about the program like improvement of patient outcome due to following of the antimicrobial stewardship program.
  8. Noncompliance of proper disposal of biomedical waste, which leads to spread of infection.

What are some strategies to improve these challenges?

  • Creating awareness about antibiotic resistance, its importance and its impact on patient outcomes.
  • Making the health care professionals follow the infection control practices through conducting training and IEC activities every year.
  • Creating a local antibiotic policy for the empirical treatment of infections.
  • Forming an electronic health record system that would contain all date, including patient clinical diagnosis, use of appropriate antibiotics and their correct dose and duration.
  • Strictly monitoring antibiotic use and reviewing the antibiotic use by all health care professionals.
  • Preparing antibiotic susceptibility of all the organisms isolated in different departments and creating local antibiotic guidelines. These should be updated every 6 months and be made available to the treating physicians and surgeons.
  • Giving training to the pharmacist so that the daily antibiotic use in the hospital is updated.
  • Following the preauthorisation and prospective audit, which will restrict the inappropriate use of antibiotics and reduce cost.
  • Involving the public by creating awareness of antibiotic resistance due to misuse and over use and self-prescription, which should be avoided.
  • Involving the agriculture and poultry industry to restrict antibiotic use, which is the reason for the spread of antibiotic resistance.
  • Properly conducting biomedical waste disposal by giving training to health professionals every year.

What is the way forward?

There is still much more to do and a long way to go to reduce antimicrobial resistance and save the pill for those that are really ill. If there is no action today there is no cure tomorrow, so it is important to really follow the antimicrobial stewardship programme and be involved.

Interested in learning more about antimicrobial stewardship programmes and how they can be applied at your hospital? POLHN offers a free, accredited antimicrobial stewardship online course, which you can take by clicking here.