HHS Public Access Author manuscript Author Manuscript
Lancet Infect Dis. Author manuscript; available in PMC 2017 July 12. Published in final edited form as: Lancet Infect Dis. 2017 March ; 17(3): 257–258. doi:10.1016/S1473-3099(17)30073-7.
Educating front-line clinicians worldwide: a crucial aspect of the collaborative struggle against antimicrobial resistance Elizabeth Robilotti, MD, MPHa, Marisa Holubar, MD, MSb, Saskia Nahrgang, MD, MPHc, Nienke van de Sande-Bruinsma, PhDc, Danilo Lo Fo Wong, PhDc, and Stan Deresinski, MDb aDepartment
of Medicine, Infectious Diseases Service, Memorial Sloan Kettering Cancer Center, New York, NY
Author Manuscript
bDepartment
of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
cControl
of Antimicrobial Resistance, Communicable Disease and Health Security, WHO Regional Office for Europe, Copenhagen, Denmark
Author Manuscript
We congratulate Goff and colleagues for their articulate and timely call for international collaboration to address the global public health problem of antibiotic resistance.1 As they indicate, “The Lancet Infectious Diseases Commission and WHO have highlighted the need for such an effort to support resource-limited countries in optimising antibiotic use through education and stewardship.” As part of their call for enhanced education of health care providers regarding optimal antimicrobial use, they highlight a number of available educational resources, including three we developed that are freely available at https:// med.stanford.edu/cme/learning-opportunities/antimicrobialstewardship.html. The thirst for education about antimicrobial use is evident from the fact that our first two courses have been accessed by individuals from more than 124 countries (Figure 1). We, nonetheless, recognize that the creation of engaging high-level educational material sufficiently specific to the circumstances faced by individual practitioners in widely different venues and with variable backgrounds and knowledge is a daunting task.
Author Manuscript
Targeted educational content may be most important for resource-limited settings. In response to this need, we are collaborating to develop online educational templates suitable for adaptation by individual countries based on their clinical needs, practical circumstances, and native language. The development of these stewardship training modules is part of a multi-modal WHO effort that recognizes the fight against antimicrobial resistance depends on a three key focus areas: stewardship education; improvement of clinical microbiology and reporting; and (pharmaceutical) regulatory interventions.2 Aimed at front-line clinicians in all settings, the material in development reviews the principles of optimal antimicrobial use as they apply to commonly encountered infections, including upper and lower respiratory infections, urinary tract infections, skin and soft tissue infections among many others. We demonstrate how stewardship principles, including the appropriate use of diagnostics, can be incorporated with simple adjustments in the clinician’s approach to a patient. Collectively, the modules highlight best practices for clinical management, but also emphasize the ubiquity of good antimicrobial stewardship
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opportunities in everyday clinical practice. We envision that these templates will be utilized to develop dedicated country specific stewardship training programs suitable to address the needs of the country’s front-line health care providers. A supplementary toolkit for stewardship program implementation is also under development as a correlative to the clinical modules that can be adapted to individual county settings. We hope to impart learners throughout the world with a new clinical framework anchored on practicing optimal antimicrobial prescribing and inspire them to become antimicrobial stewardship champions.
References
Author Manuscript
1. Goff DA, Kullar R, Goldstein EJC, et al. A global call from five countries to collaborate in antibiotic stewardship: united we succeed, divided we might fail. Lancet Infect Dis. Nov.2016 doi: 10.1016/ S1473-3099(16)30386-3 2. Food and Agriculture Organization of the United Nations, World Organisation for Animal Health, World Health Organization. [Accessed December 20, 2016] Antimicrobial resistance: a manual for developing national action plans. http://apps.who.int/iris/bitstream/ 10665/204470/1/9789241549530_eng.pdf?ua=1. Published 2016
Author Manuscript Author Manuscript Lancet Infect Dis. Author manuscript; available in PMC 2017 July 12.
Robilotti et al.
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Figure 1.
Stanford courses on antimicrobial stewardship have been accessed by learners in 124 countries. (dark gray = countries that have accessed our courses.)
Author Manuscript Lancet Infect Dis. Author manuscript; available in PMC 2017 July 12.
Lancet Infect Dis. Author manuscript; available in PMC 2017 July 12. Published in final edited form as: Lancet Infect Dis. 2017 March ; 17(3): 257–258. doi:10.1016/S1473-3099(17)30073-7.
Educating front-line clinicians worldwide: a crucial aspect of the collaborative struggle against antimicrobial resistance Elizabeth Robilotti, MD, MPHa, Marisa Holubar, MD, MSb, Saskia Nahrgang, MD, MPHc, Nienke van de Sande-Bruinsma, PhDc, Danilo Lo Fo Wong, PhDc, and Stan Deresinski, MDb aDepartment
of Medicine, Infectious Diseases Service, Memorial Sloan Kettering Cancer Center, New York, NY
Author Manuscript
bDepartment
of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
cControl
of Antimicrobial Resistance, Communicable Disease and Health Security, WHO Regional Office for Europe, Copenhagen, Denmark
Author Manuscript
We congratulate Goff and colleagues for their articulate and timely call for international collaboration to address the global public health problem of antibiotic resistance.1 As they indicate, “The Lancet Infectious Diseases Commission and WHO have highlighted the need for such an effort to support resource-limited countries in optimising antibiotic use through education and stewardship.” As part of their call for enhanced education of health care providers regarding optimal antimicrobial use, they highlight a number of available educational resources, including three we developed that are freely available at https:// med.stanford.edu/cme/learning-opportunities/antimicrobialstewardship.html. The thirst for education about antimicrobial use is evident from the fact that our first two courses have been accessed by individuals from more than 124 countries (Figure 1). We, nonetheless, recognize that the creation of engaging high-level educational material sufficiently specific to the circumstances faced by individual practitioners in widely different venues and with variable backgrounds and knowledge is a daunting task.
Author Manuscript
Targeted educational content may be most important for resource-limited settings. In response to this need, we are collaborating to develop online educational templates suitable for adaptation by individual countries based on their clinical needs, practical circumstances, and native language. The development of these stewardship training modules is part of a multi-modal WHO effort that recognizes the fight against antimicrobial resistance depends on a three key focus areas: stewardship education; improvement of clinical microbiology and reporting; and (pharmaceutical) regulatory interventions.2 Aimed at front-line clinicians in all settings, the material in development reviews the principles of optimal antimicrobial use as they apply to commonly encountered infections, including upper and lower respiratory infections, urinary tract infections, skin and soft tissue infections among many others. We demonstrate how stewardship principles, including the appropriate use of diagnostics, can be incorporated with simple adjustments in the clinician’s approach to a patient. Collectively, the modules highlight best practices for clinical management, but also emphasize the ubiquity of good antimicrobial stewardship
Robilotti et al.
Page 2
Author Manuscript
opportunities in everyday clinical practice. We envision that these templates will be utilized to develop dedicated country specific stewardship training programs suitable to address the needs of the country’s front-line health care providers. A supplementary toolkit for stewardship program implementation is also under development as a correlative to the clinical modules that can be adapted to individual county settings. We hope to impart learners throughout the world with a new clinical framework anchored on practicing optimal antimicrobial prescribing and inspire them to become antimicrobial stewardship champions.
References
Author Manuscript
1. Goff DA, Kullar R, Goldstein EJC, et al. A global call from five countries to collaborate in antibiotic stewardship: united we succeed, divided we might fail. Lancet Infect Dis. Nov.2016 doi: 10.1016/ S1473-3099(16)30386-3 2. Food and Agriculture Organization of the United Nations, World Organisation for Animal Health, World Health Organization. [Accessed December 20, 2016] Antimicrobial resistance: a manual for developing national action plans. http://apps.who.int/iris/bitstream/ 10665/204470/1/9789241549530_eng.pdf?ua=1. Published 2016
Author Manuscript Author Manuscript Lancet Infect Dis. Author manuscript; available in PMC 2017 July 12.
Robilotti et al.
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Author Manuscript Author Manuscript Author Manuscript
Figure 1.
Stanford courses on antimicrobial stewardship have been accessed by learners in 124 countries. (dark gray = countries that have accessed our courses.)
Author Manuscript Lancet Infect Dis. Author manuscript; available in PMC 2017 July 12.
