Antimicrobial stewardship and clinical pharmacist interventions in an Indian tertiary care hospital

Abstract

AbstractObjectiveComprehensive antimicrobial stewardship programs (ASPs) are needed in Indian healthcare settings due to high rates of communicable diseases and excessive antibiotic use. However, the implementation of both ASPs and clinical pharmacists (CPs) into the system is still in its nascent stages in India. Therefore, our study aims to evaluate the type and acceptance rates of CP interventions in the implementation of ASPs and its impact on antimicrobial utilization.MethodsA single‐center quasi‐experimental study was conducted at Jehangir Hospital, India, wherein prescribed antimicrobials were subjected to evaluation by CPs using the prospective audit and feedback approach. The antimicrobials were reviewed for loading dose, dosages as per creatinine clearance (CrCl), weight, suitability with site of infection, drug interactions, de‐escalations, and therapeutic duplications. Impact on antimicrobial utilization in pre‐intervention (April 2021 to March 2022) and intervention (April 2022 to March 2023) periods were compared using daily defined dose (DDD) per 1000 in‐patient days, following World Health Organization (WHO) guidelines.ResultsDuring the intervention period, 485 out of 609 proposed interventions (79.6%) were implemented. Of these, 417 (85.9%) pertained to intravenous (IV) antimicrobials, while the remaining 68 (14.1%) involved oral formulations. Notably, interventions proposing antibiotic de‐escalations showed higher acceptance rates on Days 3, 5, 7, and 10 compared with other days (p = 0.027). Dosing based on CrCl yielded the highest acceptance rate (50/56, 89.2%). Significant reductions were observed in the DDDs of polymyxins by 58% (3.48–1.29), carbapenems by 7% (57.09–52.85), and glycopeptides by 10% (47.44–42.73). The reduction in these three classes combined was statistically significant (p = 0.04, 95% confidence interval [CI] = 0.3–7.0).ConclusionThis study highlights the vital role of CP interventions within the healthcare team in optimizing antimicrobial pharmacotherapy. The noteworthy reduction in DDDs of restricted antimicrobials provides compelling evidence of the impact CPs can have on antimicrobial consumption and the fight against antimicrobial resistance.