Impact of pharmacist-led antibiotic stewardship program in a PICU of low/middle-income country

Haque, Anwarul; Hussain, Kashif; Ibrahim, Romesa; Abbas, Qalab; Ahmed, Sheraz; Jurair, Humaira; Ali, Syed Asad

doi:10.1136/bmjoq-2017-000180

Cited by 28 publications

(52 citation statements)

References 11 publications

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“…Eighteen papers (18/113, 15.9%)[40-42, 51, 54, 60, 71, 85, 87, 91, 98, 105, 106, 125, 135, 136, 138, 142] showed an increase in compliance among prescribing physicians; half of the papers analysing this outcome were from USA and Canada (10/18, 55.5%), and the main ASPs adopted were guidelines (9/34, 26.5%)[40,42,54,60,85,87,91,106,125,142], doctors education (5/34, 14.7%)[54,91,98,138,142] and other not common ASPs such as antibiotic order set[42,51], and checklists[87,91]. Sixteen of the included studies[16/113, 14.2% in total; 7/16 (43.7%) from USA, 6/16 (37.5%) from Asia and the rest (18.7%) from Europe] quantified cost savings related to the intervention[39,49,52,64,66,69,73,86,89,92,97,101,102,[122][123][124]. Decreases in costs were most often due to lower rates of drug administration.…”

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confidence: 99%

Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

Donà

Barbieri

Daverio

et al. 2020

Antimicrob Resist Infect Control

113

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Background: Antibiotics are the most common medicines prescribed to children in hospitals and the community, with a high proportion of potentially inappropriate use. Antibiotic misuse increases the risk of toxicity, raises healthcare costs, and selection of resistance. The primary aim of this systematic review is to summarize the current state of evidence of the implementation and outcomes of pediatric antimicrobial stewardship programs (ASPs) globally. Methods: MEDLINE, Embase and Cochrane Library databases were systematically searched to identify studies reporting on ASP in children aged 0-18 years and conducted in outpatient or in-hospital settings. Three investigators independently reviewed identified articles for inclusion and extracted relevant data. Results: Of the 41,916 studies screened, 113 were eligible for inclusion in this study. Most of the studies originated in the USA (52.2%), while a minority were conducted in Europe (24.7%) or Asia (17.7%). Seventy-four (65.5%) studies used a before-and-after design, and sixteen (14.1%) were randomized trials. The majority (81.4%) described in-hospital ASPs with half of interventions in mixed pediatric wards and ten (8.8%) in emergency departments. Only sixteen (14.1%) studies focused on the costs of ASPs. Almost all the studies (79.6%) showed a significant reduction in inappropriate prescriptions. Compliance after ASP implementation increased. Sixteen of the included studies quantified cost savings related to the intervention with most of the decreases due to lower rates of drug administration. Seven studies showed an increased susceptibility of the bacteria analysed with a decrease in extended spectrum beta-lactamase producers E. coli and K. pneumoniae; a reduction in the rate of P. aeruginosa carbapenem resistance subsequent to an observed reduction in the rate of antimicrobial days of therapy; and, in two studies set in outpatient setting, an increase in erythromycin-sensitive S. pyogenes following a reduction in the use of macrolides. Conclusions: Pediatric ASPs have a significant impact on the reduction of targeted and empiric antibiotic use, healthcare costs, and antimicrobial resistance in both inpatient and outpatient settings. Pediatric ASPs are now widely implemented in the USA, but considerable further adaptation is required to facilitate their uptake in Europe, Asia, Latin America and Africa.

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confidence: 99%

Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

Donà

Barbieri

Daverio

et al. 2020

Antimicrob Resist Infect Control

113

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“…Studies conducted in LMICs have shown that models of stewardship using non-specialized health care providers such as clinical pharmacists can lead to reductions in antimicrobial consumption (11)(12)(13). However, clinical pharmacists play a predominantly dispensing role in most LRS hospitals and hardly ever interact with physician members of the treating teams-remaining unknown entities in terms of potential contribution to clinical decision-making (14).…”

Section: Introductionmentioning

confidence: 99%

Half of Prescribed Antibiotics Are Not Needed: A Pharmacist-Led Antimicrobial Stewardship Intervention and Clinical Outcomes in a Referral Hospital in Ethiopia

Gebretekle

Mariam

Taye

et al. 2020

Front. Public Health

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Conclusions: A pharmacist-led AMS intervention focused on duration of antibiotic treatment was feasible and had good acceptability in our setting. Cessation of audit-feedback activities was associated with immediate and sustained increases in antibiotic consumption reflecting a rapid return to baseline (pre-intervention) prescribing practices, and worse clinical outcomes (increased length of stay and in-hospital mortality). Pharmacist-led audit-feedback activities can effectively reduce antimicrobial consumption and result in better-quality care, but require organizational leadership's commitment for sustainable benefits.

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“…Physicians knowledge could be improved if hospital pharmacists had a heightened role in educating as well as monitoring antimicrobial utilization, which is implemented in many countries of the world. Developing ASP and implementing them is also included in the role of hospital pharmacists ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

Physicians' Perspective on Prescribing Patterns and Knowledge on Antimicrobial Use and Resistance in Penang, Malaysia: A Qualitative Study

Ali

Khan

Zainal

et al. 2020

Front. Public Health

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Background: Unnecessary antimicrobial use is an emerging problem throughout the world. To design future interventions to ensure rational antimicrobial use and decrease the risk of antimicrobial resistance, physician's knowledge and prescribing practices of antimicrobials should be assessed. Therefore, the main objective of this study is to investigate the physician's knowledge along with their prescribing patterns of antimicrobials in their health care system.Methods: The present qualitative study was conducted in a tertiary care public hospital located at Penang island, situated in Northwest of Malaysia. A total of 12 semi-structured, face to face interviews were conducted with purposive sampling technique. Physicians recruited had different specialties. All interviews were audio recorded, then transcribed into English language and analyze by thematic content analysis.Results: Four major themes were identified: (1) prescribing patterns of physicians regarding antimicrobials; (2) physician's knowledge about antimicrobials; (3) antimicrobial resistance; (4) satisfaction with management of infections. Physicians believed in regular educational activities and updates about the latest antimicrobial guidelines may change the prescribing behavior of physicians to optimize the use of antimicrobials. This may lead to decrease in burden of antimicrobial resistance in their health care system. Physicians emphasized that stricter rules and regular monitoring of antimicrobial use should be implemented to overcome the main challenges of antimicrobial resistance.Conclusion: Different factors were identified to assist optimized use of antimicrobials and decrease the risk of antimicrobial resistance. The present study helps to design targeted future interventions to ensure rational antimicrobial use and decrease the impact of antimicrobial resistance in Malaysia.

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Impact of pharmacist-led antibiotic stewardship program in a PICU of low/middle-income country

Cited by 28 publications

References 11 publications

Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

Half of Prescribed Antibiotics Are Not Needed: A Pharmacist-Led Antimicrobial Stewardship Intervention and Clinical Outcomes in a Referral Hospital in Ethiopia

Physicians' Perspective on Prescribing Patterns and Knowledge on Antimicrobial Use and Resistance in Penang, Malaysia: A Qualitative Study

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