Prompt antimicrobial therapy for an infected patient can make the difference between cure and death or long-term disability. Unfortunately, the use and misuse of antimicrobials has driven the relentless expansion of resistant microbes leading to a loss of efficacy of these “miracle drugs”.
Improving antimicrobial use
Because of their widespread availability and familiarity, generally low cost, and relative safety, antimicrobials are among the most misused of all medicines. Improving antimicrobial use decisions ultimately involves guiding treatment decisions made by patients and healthcare providers.
Increase appropriate use
Ensure that infected patients who need antimicrobial therapy have access to quality medicines which conform with policy recommendations and standard treatment guidelines.
Decrease inappropriate use
Discourage the indiscriminate use of antimicrobials in patients unlikely to derive any benefit.
Educational and regulatory strategies
The WHO Medicines Department provides guidance into educational and regulatory strategies for improving the use of medicines by patients, healthcare professionals, and national authorities.
- WHO Global strategy for containment of antimicrobial resistance
- Rational drug use
- National medicines policy
- Drug regulation
- Essential drug lists
The role of surveillance
Information on local disease patterns, trends in antimicrobial resistance, and antimicrobial use behavior is needed to support clinical decisions, to guide the development of standard treatment guidelines and national formularies which reflect local infection and resistance patterns, and to evaluate the impact of interventions.
Non-human use of antimicrobials
Worldwide, the bulk of antimicrobials administered are not consumed by patients, but rather are given to animals, including cattle, sheep, chicken, and fish, for purposes of food production. Antimicrobials are used:
- to treat disease in sick animals;
- prophylactically to avoid disease in animals at high risk; and
- most controversially as growth promoters in order to raise larger animals for the same amount of animal feed and investment.
In addition to their use in animal husbandry, antimicrobial additives are used in companion animals (including pets), plant agriculture (fruits, vegetables, and orchids, etc.), and industrial applications (oil pipelines, industrial paints).
The use of immense quantities of antimicrobials in food production and the unintended wide release of antimicrobials into the environment through animal and human sewage and runoff water from agricultural sites has public health consequences, most clearly seen in resistant zoonotic bacteria associated with foodborne disease in humans. Of great concern, though of uncertain qualitative and quantitative import is the potential passage of resistance genes from bacteria of animal origin to human pathogens.
Documents on rational drug use
- How to improve the use of medicines by consumers [pdf 5.5Mb] (2007)
- Drug and Therapeutics committees: a practical guide [pdf 870kb] (2003)
- Promoting rational use of medicines: core components [pdf 106kb] (2002)
- Teacher's guide to good prescribing [pdf 814kb] (2001)
- Guide to good prescribing [pdf 314kb] (1994)