Association Between Antimicrobial Stewardship Programs and Antibiotic Use Globally

Abstract

ImportanceAntimicrobial resistance continues to spread rapidly at a global scale. Little evidence exists on the association of antimicrobial stewardship programs (ASPs) with the consumption of antibiotics across health care and income settings.ObjectiveTo synthesize current evidence regarding the association between antimicrobial stewardship programs and the consumption of antibiotics globally.Data SourcesPubMed, Web of Science, and Scopus databases were searched from August 1, 2010, to Aug 1, 2020. Additional studies from the bibliography sections of previous systematic reviews were included.Study SelectionOriginal studies of the association of ASPs with antimicrobial consumption across health care and income settings. Animal and environmental studies were excluded.Data Extraction and SynthesisFollowing the Preferred Reporting Items in Systematic Reviews and Meta-Analyses guideline, the pooled association of targeted ASPs with antimicrobial consumption was measured using multilevel random-effects models. The Effective Public Health Practice Project quality assessment tool was used to assess study quality.Main Outcomes and MeasuresThe main outcome measures were proportion of patients receiving an antibiotic prescription and defined daily doses per 100 patient-days.ResultsOverall, 52 studies (with 1 794 889 participants) measured the association between ASPs and antimicrobial consumption and were included, with 40 studies conducted in high-income countries and 12 in low- and middle-income countries (LMICs). ASPs were associated with a 10% (95% CI, 4%-15%) reduction in antibiotic prescriptions and a 28% reduction in antibiotic consumption (rate ratio, 0.72; 95% CI, 0.56-0.92). ASPs were also associated with a 21% (95% CI, 5%-36%) reduction in antibiotic consumption in pediatric hospitals and a 28% reduction in World Health Organization watch groups antibiotics (rate ratio, 0.72; 95% CI, 0.56-0.92).Conclusions and RelevanceIn this systematic review and meta-analysis, ASPs appeared to be effective in reducing antibiotic consumption in both hospital and nonhospital settings. Impact assessment of ASPs in resource-limited settings remains scarce; further research is needed on how to best achieve reductions in antibiotic use in LMICs.

The impact of the COVID‐19 pandemic on antibiotic consumption and prevalence of pathogens in primary and secondary healthcare settings in Northern Ireland

“…Of note, AMS was shown to be effective in reducing antibiotic consumption in both hospital and nonhospital settings in a recent systematic review and meta-analysis. 52 Other studies showed the feasibility of implementing effective AMS interventions during the COVID-19 pandemic in healthcare settings. 53,54 Our data showed an upward trend in the hospital-based use of coamoxiclav (amoxicillin/clavulanic acid) during all waves of the COVID-19 pandemic.…”

“…It is therefore important that the AMR/ antimicrobial consumption (AMC) targets are revisited and attention to the matter is amplified. Of note, AMS was shown to be effective in reducing antibiotic consumption in both hospital and nonhospital settings in a recent systematic review and meta‐analysis 52 . Other studies showed the feasibility of implementing effective AMS interventions during the COVID‐19 pandemic in healthcare settings 53,54 …”

A survey study on antibiotic prescription practices for acute asthma exacerbations: An European academy of allergy and clinical immunology task force report

“…Antimicrobial stewardship programs are associated with a reduced proportion of antibiotic prescriptions 19 . There are conflicting results in the literature about the effect of education on prescription practices.…”

Optimization of Therapy and the Risk of Probiotic Use during Antibiotherapy in Septic Critically Ill Patients: A Narrative Review

“…Without an appropriate measure, this may increase to 10 million deaths annually by 2050 [ 81 ]. ASP, as a measure within the One Health transdisciplinary action, decreased the consumption of antibiotics by up to 28% [ 82 ]. Moreover, implementing ASP using a multidisciplinary approach for PK/PD analysis reduced the rate of MDR in ICU-acquired infections by almost 9% [ 83 ].…”