Antibiotic Stewardship

Antimicrobial stewardship is the coordinated use of clinical, laboratory, pharmacy, infection-prevention, and system processes to optimise antimicrobial selection, dose, route, and duration. The aim is better treatment for the individual patient while limiting resistance, toxicity, Clostridioides difficile infection, and avoidable cost. It is not a policy of withholding antibiotics or choosing the cheapest drug. Resistance is selected, not created from nothing by a prescription. An antimicrobial suppresses susceptible bacteria and leaves resistant subpopulations in the patient’s flora or infecting population with a survival advantage. Mobile genetic elements such as plasmids, transposons, and integrons can then move resistance determinants between bacterial species. Broad-spectrum therapy also removes protective colonic anaerobes, allowing C. difficile to germinate and produce toxins A and B. The Canadian prescribing context makes this a community and hospital issue. PHAC reports that community antimicrobial use returned to approximately pre-pandemic levels after a 24% rebound between 2020 and 2024; more than 25% of hospital prescriptions are inappropriate or suboptimal, and most Canadian antimicrobial use by volume occurs in the community. More than 70% of community use is in the WHO...