Antimicrobial Stewardship – Implementation and Improvements in Antibiotic-Prescribing Practices in a Dental School

Abstract

Background and Aim: Antimicrobial stewardship (AMS) is a coordinated systematic approach aimed at educating prescribers to follow evidence-based prescription practice to reduce misuse of antimicrobials and thus antimicrobial resistance (AMR). We aimed to improve the standards of antimicrobial prescribing in a dental school by implementing AMS. Materials and Methods: A retrospective (first) clinical audit of antibiotic prescriptions (n = 200) over a 6 months' period was analyzed for the following parameters: type of antibiotic, clinical condition, compliance to national guidelines, and errors in prescriptions. In response to the results of this audit, an educational intervention workshop was conducted for clinical faculty. A validated self-administered questionnaire on perception and practice of antimicrobial prescribing was given to participants (n = 31) before and after the workshop and t-test was used to compare the mean scores of responses. Prospective clinical audits were conducted 6 months (second) and 1 year (third) after the workshop assessing the same parameters. A Strengths, Weaknesses, Opportunities, and Threats analysis of the AMS program was also done. Results: The total number of prescriptions issued was 943 in the first audit, which reduced to 552 in the second audit and further to 435 in the third audit. The most commonly prescribed antibiotic was a combination of amoxicillin and metronidazole. The percentage of prescriptions in accordance with national guidelines improved from 19% during the first audit to 54% and 79% in the subsequent audits. The percentage of erroneous prescriptions was 23% in the first audit, which reduced to 12% in the second audit and 9% in the third audit. The pre- and posttest mean values of the questionnaire when compared suggested that there is a need for uniformity in prescribing antimicrobials. Conclusions: Clinical audits with educational workshops on appropriate use of antibiotics have a positive impact on conforming with prescription guidelines. This will encourage the rational prescription of antibiotics based on clinical needs of patients, thus contributing to the fight against AMR.