The Core elements of human antibiotic stewardship programs in resource-limited settings : national and hospital levels
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The Core elements of human antibiotic stewardship programs in resource-limited settings : national and hospital levels

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      Global, coordinated action to address the rising threat of antimicrobial resistance (AMR) is a public health priority. Rates of AMR have been increasing worldwide; limited available data also demonstrate high rates of AMR in low- and middle-income countries (LMIC) where resources to combat resistance may be insufficient [1–3]. The World Health Organization released

      its Global Action Plan (GAP) to combat AMR in 2015, a key component of which is the development and implementation of antibiotic stewardship programs (ASP)[4].

      Antibiotic stewardship refers to coordinated efforts and activities that seek to measure and improve use of antibiotics. Implementation of ASPs has demonstrated positive public health and clinical impacts including reducing costs, lengths of hospital stays, and the burden of antibiotic resistance while maintaining or improving patient outcomes [5,6]. The U.S. Centers for Disease Control and Prevention (CDC) released the Core Elements of Hospital Antibiotic Stewardship Programs in 2014, which outlines essential components for ASPs in hospitals and provides practical guidance for implementing a robust ASP

      in an acute care facility [7]. Variations to the Core Elements have been developed to deal with the particular challenges in small, rural or critical access hospitals in the United States [8] and in outpatient facilities [9] and nursing homes.

      However, to date, implementation strategies have all been aligned with expected resources in high-income countries, such as the United States, that have robust regulatory frameworks and well-functioning healthcare systems. Practical, high-yield strategies to implement the Core Elements concepts in international resource-limited settings with weak health systems are urgently needed to move ASPs forward in such settings. Such strategies must be feasible, sustainable, and tailored to the resources that are currently available in such countries while capacity is built in areas of need to ensure access and reduce the inappropriate use of antibiotic agents. Additionally ASPs must be aligned with other national and international public health programs, such as the global sepsis initiative, so that conflicting guidance on antibiotic use is avoided.


      Suggested citation: CDC. The Core Elements of Human Antibiotic Stewardship Programs in Resource -Limited Settings: National and Hospital Levels. Atlanta, GA:

      US Department of Health and Human Services, CDC; 2018. Available at:


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