How to improve antibiotic use in my hospital: a practical course to antibiotic stewardship in the former Yugoslav Republic of Macedonia


Antibiotic resistance is one of the greatest threats to global health today. It is rising to dangerously high levels in all parts of the world, compromising the ability to treat infectious diseases and undermining many advances in health and medicine. It can affect anyone, of any age, in any country.

Recognizing the importance of this issue and the long-term benefits of well informed health policy-making, the WHO Regional Office for Europe and WHO Country Office in the former Yugoslav Republic of Macedonia, in collaboration with the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Antibiotic Policies (ESGAP), organized a two-day course to provide a practical introduction to antibiotic stewardship at the hospital level. The national partners and organizers of the course were the Institute of Public Health and the Centre for Regional Policy Research and Cooperation Studiorum.

The course, held on 25–26 January 2017 in Skopje, the former Yugoslav Republic of Macedonia, was attended by 30 participants from 13 hospitals from across the country. Its aims were:

  • to raise understanding of the problems of antimicrobial resistance across global, national and local levels;
  • to enable participants to understand and describe the core elements of antimicrobial stewardship in hospitals
  • to raise awareness of the main barriers to the development of antimicrobial stewardship programmes in hospitals
  • to train trainers for the development of antimicrobial stewardship programmes in hospital settings; and
  • to enable participants to apply improvement strategies for antimicrobial stewardship programmes at the facility level.

To increase the support of policy-makers, the introductory part of the course was designed to discuss the key challenges and possible solutions for antimicrobial stewardship. It was attended by a number of policy-makers and other stakeholders from the Ministry of Health, Health Insurance Fund, professional associations and the academic community, as well as hospital managers. Introductory lectures were given by key stakeholders from the National Committee for Antimicrobial Resistance, the Department for Pharmacy at the Health Insurance Fund and the Centre for Family Medicine at the Medical Faculty in Skopje, as well as the national antimicrobial resistance focal point. The course was delivered by an experienced international team from ESGAP.

The participants successfully produced a number of solid action plans to implement at the hospital level, and concluded that continuous support and efforts are the key to successfully addressing the issue of rational use of antibiotics, with the aim of mitigation and prevention of further spread of antimicrobial resistance.