ANTIMICROBIAL STEWARDSHIP : A GUIDE TO RATIONAL ANTIBIOTIC PRESCRIPTION

Dr. Ambuj Shandil; Dr. Jayshree M; Dr. Arun Bansal; Dr. Karthi N; Dr Arnav Shandil

Volume : VIII, Issue : VIII, August - 2019

ANTIMICROBIAL STEWARDSHIP : A GUIDE TO RATIONAL ANTIBIOTIC PRESCRIPTION

Dr. Ambuj Shandil, Dr. Jayshree M, Dr. Arun Bansal, Dr. Karthi N, Dr Arnav Shandil

Abstract :

Background and objectives : The concept of rational prescription of antibiotics known as antibiotic stewardship involves a multifaceted approach to combat the control cost and improve clinical outcome by improving antimicrobial use. Antibiotic prescribing may also be influenced by what we call as �prescribing etiquette� which often leads to prescriber being reluctant to alter their colleague�s prescription. To address this gap in knowledge and to support prescribers in their efforts to treat patient effectively, antibiotic stewardship programmes needs to be advocated. Antibiotic stewardship refers to multifaceted approach (including multiple guidelines, policies, prevalence, surveillance, reports, education and audit of practice) that healthcare organizations have adopted to optimize prescribing to improve clinical outcomes and control costs. Most of the studies on ASP are in adults and that too from developed countries. Emerging economies contribute significantly to the burden of AMR, mainly due to indiscriminate use, and poor prescribing guidelines. To add to this the higher sickness level of patients, and coexisting co- morbidities like malnutrition, pushes clinicians toward frequent empiric use of antibiotics. The clinicians have to walk a tight rope, balancing between early appropriate use and avoiding prolonged inappropriate use of antimicrobials We therefore decided to conduct this before and after study to test the feasibility of a clinical ASP with respect to rational antimicrobial use(number, dose, appropriateness and upgradation) Methods: This study was a prospective before and after study design which was divided into 3 phases over a span of 12 months . A pre- implementation audit (phase 1)was conducted for 1st 3 months studying various prescription practices that were being followed in ICU and general observation. Antimicrobial stewardship was implemented in phase 2 for a period of 6 months. After the implementation of ASP in PICU, a similar audit on antimicrobial prescription and usage was done in next three months (phase 3) and the results compared with the audit of pre-implementation period Results : Our study was designed to note effect of antimicrobial stewardship on rational antimicrobial use (number, dose, appropriateness and upgradation).We observed that before implementation of a formal ASP the number and duration of antibiotics were significantly higher in the pre-implementation phase as compared to post implementation phase. We observed that not only there was a significant drop in number and duration of antibiotic use but also a statistically significant reduction in the number of inappropriately prescribed treatment