Preface Open Access

To prescribe antibiotics appropriately requires access to information and guidance from multiple sources. In prescribing for individual patients, the first line of information relates to specific isolate and antimicrobial resistance data. This data may not be available within the time window to be useable, and for many patients who have infections for which there is no isolate, it may not be available at all.

The second line of information is that relating to antimicrobial resistance commonly encountered among the patients presenting with the syndrome that the antibiotics are being prescribed to treat. This second line of data requires information that is robust and relevant.

Moreover, unlike other classes of drugs, in the use of antibiotics, there is a third line of information and guidance. The use of antibiotics requires consideration of other factors such as antimicrobial resistance surveillance and antimicrobial stewardship in the hospital environment, in the outpatient clinic, in long-term care facilities and in the community. In this regard, where the interface between hospital, community and long-term care facilities sits may vary from one jurisdiction to the next. Beyond human use there is antibiotic used in animal medicine. Antibiotic therapy must recognize the One Health approach to infectious diseases. This is especially challenging given that the bacteria causing infections are not limited by international borders. Nor are they necessarily limited to human or animal domains.

The five consensus articles in this Supplement are white papers that address this information need from the European perspective. It represents a collaborative effort between over 50 experts from over 30 networks across more than 18 countries, representing a range of specialties that share a stake in the antimicrobial resistance surveillance and antimicrobial stewardship information pipeline. Consensus was reached on a range of issues in a process over two or three phases. In reaching this consensus, the research questions were refined, the evidence collated from the literature and finally consensus was reached. This consensus was reached usually by a Delphi process together with face-to-face interaction where possible. As might be expected, consensus was not reached in every instance and those topics for which consensus could not be reached were identified as research priorities.

It is possible that the articles share some overlap in content as they present consensus views. This is intentional as the aim is that the papers are able to stand alone and be accessible to an audience that may be operating in only one or two of the several environments from which the recommendations originate.

These articles provide consensus recommendations for antimicrobial stewardship activities. They provide support for appropriate antibiotic use. The consensus developed and presented here represents a substantial first step. However, implementation is the next challenge.

Transparency declarations

None to declare.