Preface

This book, *Antimicrobial Stewardship – New Insights*, offers valuable insights into antibiotics for researchers, academicians, pharmacists, physicians, nurses, healthcare workers, technicians, and other interested readers. In the early days of antibiotics, even as antibiotic resistance developed, a new antibiotic was always available for the treatment of increasingly resistant bacterial species. A considerable decrease in the development of new antibiotics has been observed during the past 40 years and, therefore, the options to treat increasingly resistant infections are now limited. Infections caused by antibiotic-resistant pathogens are causing millions of deaths worldwide. Antimicrobial stewardship refers to a series or program of interventions for monitoring the direct use of antimicrobials at healthcare institutions. Antimicrobial stewardship is of the utmost importance for optimizing antimicrobial uses to prevent or slow down antimicrobial resistance.

This book is organized into two sections: "Importance of Antibiotic Stewardship in Healthcare Settings" and "Antimicrobial Resistance and Antimicrobial Stewardship". In the first section, the introductory chapter provides a comprehensive overview of antimicrobial stewardship, which refers to interventions and control programs for the optimization of antibiotic usage. It also discusses the need for antimicrobial stewardship programs, strategies, evaluations, and international guidelines and approaches. Chapter 2 examines how antibiotic stewardship plays a role in the management of antibiotic resistance. The most important things include developing policies and regulations to support antibiotic stewardship in primary health care, optimizing available facilities and infrastructure, improving facilities to support antibiotic stewardship, increasing capable human resources, monitoring and evaluating antibiotic prescribing, and building system information on antibiotic resistance, which should be easily accessible to health workers in primary healthcare facilities. Chapter 3 explores the applications of antimicrobial stewardship and natural product chemistry to tackle antimicrobial resistance. It discusses how plants have contributed immensely to our traditional medicines as well as to the field of drug discovery due to the presence of plant bioactive secondary metabolites. The focus of Chapter 4 is the implementation of antimicrobial stewardship in various healthcare settings to reduce antimicrobial resistance. Chapter 5 discusses the role of antimicrobial stewardship in resource-limited settings, highlighting that the implementation of antimicrobial stewardship programs remains relatively limited and faces complex challenges in resource-poor healthcare settings. Chapter 6 shows how probiotics and their derivatives can play a role in the improvement of antimicrobial stewardship as it concerns human health. It investigates how the gut microbiota are modulated by probiotics, ghost probiotics, postbiotics, and synbiotics, and their importance in infection prevention and antibiotic stewardship. Finally, Chapter 7 is about laboratory information management system analysis, which is employed to support control of antimicrobial resistance.

The second section includes six chapters. Chapter 8 discusses the role of implementation of strict regulation and monitoring regarding the irrational use of antibiotics in

animals, sewage disposal, waste disposal, and hospital infection control practices. The spread of antimicrobial resistance in the environment is also an alarming issue for the world. Therefore, Chapter 9 examines the role of antimicrobial stewardship in controlling antimicrobial resistance in the environment. Chapter 10 discusses how an effective antimicrobial stewardship is integral to managing various infections and preventing their further escalation through antimicrobial stewardship programs, de-escalation therapy, combination therapy, antibiotic dose optimization, and prophylactic antibiotic use in those who are at high risk of infection. Chapter 11 provides a short, general review of biocompatible polymer materials and their applications in antimicrobial fields. It begins with a background of microbial threats, discussing the demands of biocompatible polymers for antimicrobial applications, then moves on to describing the basic knowledge of biocompatible polymers, including definitions, advantages, and typical examples. The chapter ends with a discussion of some approaches to utilizing biocompatible polymers in antimicrobial applications. In Chapter 12, the authors discuss the inappropriate practices of prescribing antibiotics that have led to increased multidrug resistance in bacteria, envisaging the implementation of rigorous guidelines for proper use of antibiotics in human beings. Chapter 13 covers the patho-phylotyping of diarrheagenic *Escherichia coli* interaction along with antibiotic resistance and biofilm formation capacity.

> **Ghulam Mustafa** Department of Biochemistry, Government College University Faisalabad, Faisalabad, Pakistan

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