Stewardship of antibiotic use and resistance surveillance: the international scene.

Audit is all about education and changing practice. It is well known that doctors are both difficult to target with educational initiatives and those who need educating are the most difficult to target! Changing established practice is even harder and maintaining change in practice is often considered just a dream. This emphasises the importance of the cycle of audit, feedback (education), re-audit etc. This process has been developed over a twelve-year period in Aberdeen while the antibiotic policy has evolved from a 15-page booklet on hospital antibiotic prescribing into a 90-page book combining both hospital and general practice prescribing. Both successes and failures of the audit process will be described in the context of Strategic Goals. The next phase is assessment of performance against other policies in Europe to establish the best methods of antibiotic stewardship. A European group has recently been formed to begin this process. Parameters that can be used to assess the comparative performance of policies will be discussed and include antibiotic resistance rates. Several international resistance surveillance and quality of antibiotic use programmes are highlighted.