1.1 AMS in the clinical setting

AMS in the clinical setting refers to responsible AMU by healthcare professionals; and, more specifically, to selecting the most appropriate antimicrobial, duration, dose and route of administration for a given patient with a demonstrated or suspected infection. This is summarised in Figure 1.

Figure 1 The appropriate use of antimicrobial drugs.

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A figure that represents the idea that prescription and administration compliance needs to identify the right drug (correctly prescribed and documented), the right dose, the right duration, and the right frequency of administration.

Figure 1 The appropriate use of antimicrobial drugs.

The decision to recommend particular antimicrobials for specific clinical conditions depends on:

• AMR surveillance data produced at the local level as a result of good diagnostic stewardship (see the Diagnostic stewardship in clinical practice course)
• implementing surveillance programmes at national, regional and facility levels.

Establishing surveillance programmes for AMR is one of the objectives of a national action plan, and should be directed by action points once this programme is endorsed. Surveillance for AMR provides data on the levels of susceptibility or resistance to tested antimicrobials. This data can be analysed to formulate evidence-based recommendations that inform and guide clinicians, policy-makers and others on how to use antimicrobials.

For example, based on this data, empirical treatment guidelines can be put in place at different healthcare levels. It is important to understand that levels of resistance of specific organisms to specific antimicrobials may change over time, and ongoing surveillance is critical to provide information on trends and current resistance patterns. Periodic reporting of AMR data is essential to allow the provision of up-to-date recommendations for empirical treatment.

Similarly, surveillance data is also necessary to inform the choice of directed therapy when the causative organism and susceptibilities are known: if an organism is susceptible to a number of effective drugs, clinicians may choose to prescribe an antimicrobial less likely to be associated with particular resistance problems in their unit.