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Part II: Antimicrobial stewardship programme

ASP is defined as the optimal selection, dosage, route of administration and duration of antibiotic treatment (119–120).
Benefits of ASP include improved patient outcomes (121–122), reduced adverse reactions, reduced Clostridium difficile infection rate (121,123), minimal impact on subsequent antibiotic resistance (124–125) and optimisation of resource utilisation (125–126).
ASP is one of the core components of infection control which is one of the mandatory criteria in the Australian Council on Healthcare Standards Evaluation and Quality Improvement Program Hong Kong Guide (127).
It involves a multidisciplinary, programmatic, prospective, interventional approach to optimising the use of antimicrobial agents.
ASP team comprises clinical microbiologists, infectious disease physicians, infection control nurses, and infectious disease pharmacists.

Table 2.1 Methods to implement ASP in hospital setting

Preauthorisation	Restricted use of certain antibiotics Prior approval by an ASP team Reduces initiation of unnecessary / inappropriate antibiotics
Prospective audit and feedback	Use of antibiotic order form Provides educational benefit to clinicians Can increase visibility of ASP and build collegial relationships
Administrative control	Restriction of hospital drug formulary through the Drug and Therapeutics Committee Use of antibiotic order form Selective or cascade reporting of antibiotic susceptibility test results
Guidelines, education & consultation	Written hospital guidelines for common infectious diseases syndromes Educational efforts aimed at changing prescribing practices of clinicians Providing consultation from clinical microbiologist or infectious disease physician
Review and surveillance	On-going monitoring and analysis of antibiotics usage On-going surveillance of antibiotic susceptibility On-going monitoring of Clostridium difficile infection rate