Optimizing antimicrobial drug utilization through antimicrobial stewardship programme in a tertiary care referral hospital in south India

Background: Antimicrobial stewardship is defined as a rational, systematic approach to the use of antimicrobial agents in order to achieve optimal outcomes. The primary objective (strategy) of the study was to reduce the use of antimicrobial agents by the development and implementation of an Antimicrobial Stewardship Programme.(ASP) The secondary strategies comprised intravenous to oral conversion of antimicrobial agents, de-escalation therapy, reduction of medication errors etc. Methods: The study was executed as an observational phase for 75 days in general medicine inpatients and developed an Antimicrobial stewardship committee. Interpretation of the pre-interventional phase data committee selected the primary and secondary strategies. Corrective actions for the findings were made and the monitoring was re-initiated in the post interventional phase with proper recommendations by the clinical pharmacist in prospective design for the next 75 days in the same set of population. The primary strategy was indexed in terms of DDD/100 bed days for the utilization of antimicrobial agents and the secondary strategies are represented in terms of numbers and percentage difference. The significance differences were made by the statistical analysis for different strategies. Results: The Antimicrobial stewardship programme was executed and developed with fulfilled quorum committee. The primary strategy, 54% (0.5730DDD/100beddays) reduction in the use of antimicrobial agents were achieved in comparison to the observational phase, significance reduction were achieved in the doxycycline (0.296 to 0.022), oral ciprofloxacin (0.392 to 0.115) and oral moxifloxacin (0.184 to 0.021). By the proper educations, monitoring and the recommendations by the clinical pharmacist the rate of conversions of intravenous to conversion of antimicrobial agents increased from 6% to 72%(p=0.0001), the usage of multiple broad spectrum (De-escalation) antimicrobial agents decreased from 17.31% to 15% and the medication errors such as prescription error, dispensing errors and administration errors were reduced from 71.25% to 28.28%. By the programme some impact were fallen to other strategies such as number of culture sensitivity tests, duration of the therapy and resistance panel of the study site. Conclusion: The functioning of the program with heterogeneous goals in each cycle can effectively optimize the antimicrobial use and pathogen susceptibility patterns.