An overview of state and national programs to monitor and improve antimicrobial use and related legislative efforts

In 2003, it was estimated that 1.1 billion dollars was spent annually on unnecessary antibiotic prescriptions for adult upper respiratory infections in the United States; this number has undoubtedly increased. In the hospital, recent studies estimate that 30% of antimicrobials are unnecessary and inappropriate contributing to the development of antimicrobial resistance and patient toxicities, further complicated by the development of few novel antimicrobial agents in the pipeline. The plausability of a post-antibiotic era has forced clinicians and healthcare institutions to make better use of available antimicrobial agents by practicing antimicrobial stewardship. Currently, California is the only US state to have a legislative mandate requiring the judicious use of antibiotics in general acute care hospitals. The California Antimicrobial Stewardship Program (ASP) Initiative at the California Department of Public Health is the first state-based public health program with the goal of improving the appropriate use of antimicrobials in all licensed healthcare settings. This portion of the session will highlight state and national programs working to promote the appropriate use of antimicrobials within all levels of health care. We will also cover antimicrobial susceptibility and utilization surveillance efforts at the state and national levels. Finally, we will discuss current and pending state and national legislative efforts designed to address the growing problem of antibiotic resistance and the limited armamentarium of antimicrobial agents.