What is Antibiotic Policy

The antibiotic policy is the set of strategies and activities undertaken to organize the antimicrobial treatment in the hospital, and achieve health outcomes for patients. The basic principles are to be direct evidence-based medicine, local epidemiology and freedom for prescribing physicians.

An antibiotic policy is now more necessary than ever for clinical, epidemiological and economic reasons.

The Infection Committee is responsible for the antibiotics policy in hospitals. Its functions as an advisory body to the medical directorate are the analysis of the epidemiology of the infections in the centre, measures for its prevention and control, improving the appropriate use of antimicrobials, training, and knowledge production.

Objectives of the HIC committee:

• To minimize the risk of infection to patients, staff and visitors.
• To identify the roles and responsibilities of key personnel involved in the prevention and control of infection
• To maintain Surveillance over hospital acquired infections.
• To develop a system for identifying, reporting, analyzing, investigating and controlling hospital acquired infections.
• To develop and implement preventive and corrective programmes in specific situations where infection hazards exist.
• To Advice the Medical Superintendent on matters related to the proper use of antibiotics, develop antibiotic policies and recommend remedial measures when antibiotic resistant strains are detected.
• To review and update hospital infection control policies and procedures from time to time.
• To achieve clinical, environmental and economic policy objectives of antibiotics is not easy. The agreement of hundreds of professionals for recommendations on indications, dosage and duration of antibiotic treatment, based on the best scientific evidence and local guides is complex, but it can be done. The key to this is that the Infection Committee develops antimicrobial stewardship through a multidisciplinary team and professional leadership, and has the institutional support to ensure that the proper use of antimicrobials is a priority for the centre, and therefore of each of the services involved, and that the team has the resources for antimicrobial stewardship.

Principal of Treatment:

• These guidelines are based on the best available evidence.
• A dose and duration of treatment is suggested but can be modified by consultants based on clinical scenarios
• Prescribe an antibiotic only when there is likely to be a clear clinical benefit.
• Do not prescribe an antibiotic for viral sore throat, simple coughs and colds and viral diarrhoea.
• Use simple generic antibiotics first whenever possible. Avoid broad spectrum antibiotics (e.g. Amoxycillin+Clavulanate, quinolones and cephalosporins) when standard and less expensive antibiotics remain effective, as they increase risk of Clostridium difficile, MRSA and resistant UTIs.
• Avoid widespread use of topical antibiotics (especially those agents also available as systemic preparations).
• Clarithromycin is an acceptable alternative in those who are unable to tolerate erythromycin because of side effects.
• Test dose to be given for beta-lactam antibiotics.

Steps to follow the protocols:

• Identify the type of infection — bloodstream, respiratory, intra-abdominal or urinary tract.
• Define the location — OPD, ICU or floor patient
• Wait for at least 48hrs of antimicrobial therapy before labelling patient as non-responding to the therapy and to switch to the higher next line of therapy. Also consider if patient condition deteriorates.
• Send respective cultures and or primary set of investigations before starting antibiotic therapy
• Once culture / sensitivity report available initiate specific antimicrobial therapy. Antimicrobial may require to be changed/de-escalated.

Written by:

Dr. Praveen Bajpai

Director of Ingenious Healthcare Consultants Pvt. Ltd.
Founder of Skill Sathi

MBA in Hospital administration, PG Diploma in Quality Accreditation, PG Diploma in Medico Legal System, M. Phil in Hospital Mgmt. from BITS Pilani, P.hD in Management, Certified NABH Auditor, Certified NABL Auditor, Certified Auditor for Clinical Audits, Green Belt in Six Sigma, Certified in Hospital Infection Control Practices, Certified trainer for International Patient Safety Goals, Certified Auditor for JCI 7th Edition Standards 

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