Comparative Study on Antibiotic Stewardship and its Impact on Patient’s Health: Evidence-Based and Case Studies

Abstract

Background Antimicrobial abuse is connected to the emergence and dissemination of drug-resistant pathogens, as well as other problems. Morbidity, death, hospital stay periods, and healthcare costs have all risen. Antimicrobial stewardship is an overarching word for a holistic quality management approach involving evidence-based information exchange programs to optimize the usage of antimicrobials, enhance patient outcomes, minimize antimicrobial resistance, and hospital-acquired infections including Clostridium difficile, and lower healthcare costs. Antimicrobial stewardship program (ASP) aims to prevent or slow the emergence of antimicrobial resistance, optimize the selection, dosing, and duration of antimicrobial therapy, reduce the incidence of drug-related adverse events, and reduce rates of morbidity and mortality, length of hospital stay, and costs by evaluating and improving how antimicrobial agents are selected and delivered. This study was conducted in three different hospitals, from each hospital 100 patient profiles were evaluated to compare the effectiveness and benefits of the antibiotic stewardship program. A pre-designed intervention form is used for the assessment to evaluate patients' profile / Computerized Physician order entries / Manual prescriptions which contain at least one or more kinds of antibiotics. In this study, some parameters were observed as there is a total 18 number of antibiotics mostly prescribed to patients, however, in small rural hospitals there were large spectrum antibiotics were prescribed more without justification, however in tertiary care hospitals, the selection of antibiotics is based on the patient’s need, beyond that it was observed that mostly drug resistance cases occur in a small rural hospital and a small urban hospital as compared to a large tertiary hospital. Further, it was evaluated that eight different Drug-related problems (prescribing) were associated with improper use of antibiotics. i.e. the excessive duration of therapy, culture sensitivity (C/S) not followed, culture sensitivity (C/S) not Reported, high dose prescribed, and therapeutic drug monitoring (TDM) not reported, Through this study that is evaluated that in large tertiary care hospitals, ASP implemented effectively so due to that there were 25257 PKR was saved on each patient which was the cost of unwanted therapy, but in a small rural hospital and the small suburban hospital where there is no any concept of ASP, and there is no any restriction to prescribe unwanted antibiotics, due to that reason there was no saved cost at these type of hospitals.  Conclusion With the help of this limited study it was concluded that in tertiary care hospitals (where ASP was implemented) there was optimum use of antibiotics, cases of bacterial resistance were not much more, and here clinical outcomes of patients were observed more but as compare to this in a small rural hospital and small suburban hospital there were unethical use of antibiotics were observed, and no any restriction and limitations are observed toprescribe and dispense antibiotics. Instead of this, that was also observed that in tertiary care hospitals, the extra cost was saved due to short stays and proper use of antibiotics, but there was no saving in other hospitals where ASP was not implemented. So finally this is to conclude that ASP has more benefits and must be implemented in every healthcare setup.