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Overview and Evidence to Support Stewardship


Get Smart for Healthcare is focused on improving antibiotic use in inpatient healthcare settings such as acute-care facilities through the implementation of antibiotic stewardship programs designed to ensure that hospitalized patients receive the right antibiotic, at the right dose, at the right time, and for the right duration.

Antimicrobial stewardship interventions have been proven to improve individual patient outcomes, reduce the overall burden of antibiotic resistance, and save healthcare dollars. If everyone — healthcare providers, hospital administrators, policy makers, and patients — works together to employ effective antibiotic stewardship programs, we can improve patient care, more effectively combat antibiotic resistance and ultimately save lives.

Fast Facts

  • Antibiotics are a shared resource – and becoming a scarce resource.
  • 30-50% of antibiotic use in hospitals is unnecessary or inappropriate.
  • Antibiotic overuse contributes to the growing problems of Clostridium difficile infection and antibiotic resistance in healthcare facilities.
  • Reducing unnecessary antibiotic use can decrease antibiotic resistance, Clostridium difficile infections, and healthcare costs, and improve patient outcomes.
  • Interventions to improve antibiotic use can be implemented in any healthcare setting—from the smallest to the largest.
  • Improving antibiotic use is a medication-safety and patient-safety issue.

Slide Sets

Introductory Slide Set

Here is an introductory slide set that lays out the case for antibiotic stewardship interventions. Please feel free to use this slide set to help make the case for these interventions.

Training Slide Sets
Antimicrobial Resistance Across the Continuum of Care

Antimicrobial Resistance Across the Continuum of Care: Winning the War One Battle at a Time (Note: CME has expired)



Antimicrobial Stewardship for the Community Hospital: Practical Tools & Techniques for Implementation

This educational initiative was designed to overcome and address the barriers to facilitate practical implementation of Antimicrobial Stewardship Programs in the community hospital setting led by the hospital pharmacist and infectious disease specialist in conjunction with other collaborating physician specialties. These sessions were recorded during a scientific roundtable meeting that was presented by the Centers for Disease Control and Prevention and titled "Antimicrobial Stewardship for the Community Hospital: Practical Tools & Techniques for Implementation," which took place on August 24, 2010, in Atlanta, Georgia. Cooperating organizations for this initiative include the American Medical Association, the Association for Professionals in Infection Control and Epidemiology, the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the Society of Hospital Medicine, and the Society of Infectious Diseases Pharmacists.



  • Arjun Srinivasan, MD, FSHEA (Co-chair)
    Associate Director for Healthcare Associated Infection Prevention Programs
    Medical Director, Get Smart for Healthcare
    Division of Healthcare Quality Promotion
    Centers for Disease Control and Prevention
    Atlanta, GA
  • Christopher A. Ohl, MD
    Associate Professor of Medicine
    Section on Infectious Diseases
    Wake Forest University School of Medicine
    Winston-Salem, NC
  • Edward J. Septimus, MD, FIDSA, FACP, FSHEAClinical Professor of Internal Medicine
    Texas A&M Health Science Center
    Medical Director
    Infection Prevention and Epidemiology
    HCA Healthcare System
    Houston, TX
  • Elizabeth S. Dodds Ashley, PharmD, MHS, BCPS
    Associate Director of Clinical Pharmacy Services
    University of Rochester Medical Center
    Rochester, NY
  • John G. Bartlett, MD
    Professor of Medicine and Epidemiology
    Johns Hopkins University School of Medicine
    Baltimore, MD
  • Robert C. Owens Jr., PharmD (Co-chair)
    Co-Director, Antimicrobial Stewardship Program
    Clinical Pharmacy Specialist, Infectious Diseases
    Department of Pharmacy Services and Division of Infectious Diseases
    Maine Medical Center
    Portland, ME
  • Joseph S. Solomkin, MD, FACS, FIDSA
    Professor Emeritus of Surgery
    Department of Surgery
    University of Cincinnati College of Medicine
    Cincinnati, OH
  • Sara E. Cosgrove, MD, MS, FSHEA
    Associate Professor of Medicine
    Division of Infectious Diseases
    Director, Antibiotic Management Program
    Associate Hospital Epidemiologist
    Johns Hopkins Medical Institutions
    Baltimore, MD
  • Thomas M. File Jr., MD, MSc, MACP, FIDSA, FCCP
    Professor, Internal Medicine
    Head of Infectious Disease Section
    Northeastern Ohio Universities
    Colleges of Medicine & Pharmacy
    Rootstown, OH
    Chief, Infectious Disease Service
    Summa Health System, Akron, OH


Disclosure Information:

The faculty reported the following relevant financial relationships that they or their spouse/partner have with commercial interests:
John G. Bartlett, MD: Advisory Board: Tibotec, Salient, Optimer; Honoraria: Abbott, Merck
Sara Cosgrove, MD, MS, FSHEA: Advisory Board: Forest, Rib-X; Consultant: Merck; Grant Recipient: Cubist, Astellas, Advan-Dx
Elizabeth S. Dodds Ashley, PharmD, MHS, BCPS: Consultant: Pfizer; Speakers Bureau: Merck
Thomas M. File Jr., MD, MSc, MACP, FIDSA, FCCP: Advisory Board: GlaxoSmithKline, Pfizer, Merck, Novartis, Cerexa, Forest, Protez, Nabriva, Tetraphase; Research Grant Recipient: Cerexa, Forest, Pfizer, Boehringer Ingelheim, Gilead, Tibotec
Christopher A. Ohl, MD: Advisory Board: Johnson & Johnson; Consultant: Johnson & Johnson; Speakers Bureau: Pfizer, Cubist
Robert C. Owens Jr., PharmD: Consultant: TheraDoc, Premiere
Edward J. Septimus, MD, FIDSA, FACP, FSHEA: Grant Recipient: AHRQ/CDC; Speakers Bureau: Cubicin, Merck, Sage
Joseph S. Solomkin, MD, FACS, FIDSA: Advisory Board: Johnson & Johnson, Merck, Optimer; Consultant: Cubist; Grant Recipient: Pfizer
CDR Arjun Srinivasan, MD, FSHEA: Nothing to Disclose

Non-faculty content contributors and/or reviewers reported the following relevant financial relationships that they or their spouse/partner have with commercial interests:
Otto Ratz, MD; Josh Paul; Bradley Pine; Blair St. Amand; Jay Katz; Kay Weigand; Paula Larson; Nothing to Disclose

References to Support Stewardship

There is a plethora of evidence to support the case for antibiotic stewardship interventions. Here are a few that highlight impact on costs, reduction of Clostridium difficile infections, use, and more.

Vital Signs: Improving Antibiotic Use Among Hospitalized Patients
PDF version [PDF - 357 KB]

Vital Signs Technical Appendix:
Estimating the Potential Reductions in Clostridium difficile Infection (CDI) among Patients when Antibiotic Use is Improved.