Evidence brief for policy: Promoting appropriate use of antibiotics in hospitals to contain antibiotic resistance in North Macedonia (2020)

The Ministry of Health of North Macedonia commissioned this evidence brief for policy, to be published under the aegis of the WHO European Evidence-informed Policy Network, to develop evidence-informed options for the country to consider in tackling the problem of empirical prescribing of antibiotics in inpatient facilities. Such treatment currently takes place without microbiological testing, largely contributing to spread of antimicrobial resistance.

The work was carried out within the framework of the Biennial Collaborative Agreement between the Ministry of Health and WHO, involving high-level national policy institutions and national experts, and supported by technical experts of the WHO Regional Office for Europe. A working group comprising representatives from different clinical disciplines, pharmacology, public health and health care management worked on identifying, selecting, appraising and synthesizing relevant research evidence on the problem, three options for tackling it and considerations for implementing them.

The three options are:

• revision, contextualization and implementation of guidelines for antibiotic therapy, including clinical pathways and feedback between primary and secondary care;
• establishment of antibiotic stewardship programmes in hospitals, accompanied by an antibiotic use reporting system; and
• strengthening curricula on prudent antibiotic use in undergraduate, postgraduate and continuous education for all health professions.