How to assist clinicians in improving antimicrobial prescribing: tools and interventions provided by stewardship programs.

In the last decade, there has been an exponential increase in the microorganisms resistant to antimicrobials and a significant increase in the cost of these types of drugs. This phenomenon has increased interest in the development of interventions for counseling on and control of the use of antimicrobials, referred to as stewardship programs. In this article we review, from various points of view, the tools that have been developed with this purpose. First, we highlight the value of locally adapted guidelines and clinical pathways as an essential part of the operational process. Then we emphasize the importance of the relationship between microbiologists and clinicians for the accurate transmission of the information provided by blood cultures to make the most appropriate choice of antimicrobial for the patient's treatment. We also review the computerized tools that have facilitated the correct use of antimicrobials according to the controls established by the departments of pharmacy. Based on the previous tools, some programs based on "bedside recommendations" provided by multidisciplinary teams have been developed for optimizing the rational use of antimicrobials (PROA programs). Finally, we comment on the peculiarities of the programs targeting antifungals that have been developed in recent years.