Education on antibiotic use. Education systems and activities that work.

Education is a cornerstone of antimicrobial stewardships programs, because 50% of inappropriate antimicrobial prescriptions are a consequence of an imbalance between the high levels of knowledge required for the appropriate use of antibiotics and the scarce training offered to medical specialists. For this reason, programs optimizing antimicrobial (PROA) are essentially based on support and educational activities for prescribers. The educational activities are difficult to evaluate. In our country, the application of educational activities in antimicrobial training programs is very heterogeneous, although it has improved in recent years. We recommend the following educational measures, which are prioritized in order of effectiveness. Interactive educational interventions are the most effective. These are non-compulsory interventions based on real prescriptions in clinical practice and include educational outreach visits, audits and counseling interviews with feedback and multifaceted interventions. Passive educational strategies, with posters, newsletters, and dissemination of guidelines, are only marginally effective in changing antimicrobial prescribing practices and have not shown a sustained effect. These measures need extensive professional involvement and should be combined with more active approaches. Currently, interventions can be enhanced with some teaching tools in electronic format. Both interactive and passive educational measures should be integrated into the PROA and should have institutional support. Finally, we recommend including antimicrobials in the training plans of all clinical specialties.