Towards a global definition of responsible antibiotic use: results of an international multidisciplinary consensus procedure

Abstract

BackgroundConducted as part of the Driving Reinvestment in Research and Development and Responsible Antibiotic Use (DRIVE-AB) project, this study aimed to identify key elements for a global definition of responsible antibiotic use based on diverse stakeholder input.MethodsA three-step RAND-modified Delphi method was applied. First, a systematic review of antibiotic stewardship literature and relevant organization web sites identified definitions and synonyms of responsible use. Identified elements of definitions were presented by questionnaire to a multidisciplinary international stakeholder panel for appraisal of their relevance. Finally, questionnaire results were discussed in a consensus meeting.ResultsThe systematic review and the web site search identified 17 synonyms (e.g. appropriate, correct) and 22 potential elements to include in a definition of responsible use. Elements were grouped into patient-level (e.g. Indication, Documentation) or societal-level elements (e.g. Education, Future Effectiveness). Forty-eight stakeholders with diverse backgrounds [medical community, public health, patients, antibiotic research and development (R&D), regulators, governments] from 18 countries across all continents participated in the questionnaire. Based on relevance scores, 21 elements were retained, 9 were rephrased and 1 was added. Together, the 22 elements and associated best-practice descriptions comprise an exhaustive list of elements to be considered when defining responsible use.ConclusionsCombination of concepts from the literature and stakeholder opinion led to an international multidisciplinary consensus on a global definition of responsible antibiotic use. The widely diverging perspectives of stakeholders providing input should ensure the comprehensiveness and relevance of the definition for both individual patients and society. An aspirational goal would be to address all elements.

Patient-related determinants of antibiotic use: a systematic review

“…When possible, we aimed to identify 'responsible' antibiotic use as specific outcome, such as adherence to the prescribed regimen, the absence of self-medication with antibiotics and the lack of antibiotic use for viral infections. Of note, we did not pre-specify a list of aspects of 'responsible' antibiotic use because our outcome of interest was any antibiotic use and not only 'responsible' use [7].…”

“…For this reason, it seems of utmost importance to understand the determinants of antibiotic use (i.e. factors that influence and explain antibiotic prescribing by doctors and antibiotic-related behaviours of patients), to select or develop pragmatic strategies that improve such use [7].…”

Views and experiences with regard to antibiotic use of hospitalized patients in five European countries: a qualitative descriptive study

“…Interview topics derived from elements of the definition of responsible antibiotic use were identified by a systematic review of the literature [10]. These topics were A, indication for the administered antibiotics; B, characteristics of the regimen; C, diagnostics performed before or during treatment; D, adverse effects; and E, antimicrobial resistance (AMR).…”

“…This could also be applied to antibiotic care so as to improve the patient's experience. Consequently, in the context of the DRIVE-AB project [8,9], we explored (a) inpatients' experiences concerning antibiotic treatment in the five participating hospitals and (b) domains related to 'responsible' antibiotic use [10] using a patient-centred framework with the ultimate aim of understanding what defines 'appropriate' care with regard to antibiotic use at the hospital from the perspective of the patient. Of note, assessing factual knowledge with regard to antibiotics and bacterial resistance was not an objective of this study.…”

Ensuring Antibiotic Development, Equitable Availability, and Responsible Use of Effective Antibiotics: Recommendations for Multisectoral Action

“…In addition, reports from the UK provide recommendations to tackle AMR based on expert consultation [12]. Table 1) developed by the Driving Reinvestment in Research and Development and Responsible Antibiotic Use (DRIVE-AB) [13]. Twelve interviews were held with stakeholders representing the following perspectives: antibiotic R&D, health economics, medical ethics, government, health law and bioethics, public health and regulatory agency.…”