Abstract
In many parts of the world, including in India, pharmacist roles in antimicrobial stewardship (AMS) programmes remain unexplored. We describe the evolution and effect of the role of adding clinical pharmacists to a multidisciplinary AMS at a tertiary care teaching hospital in Kerala, India. Through effective leadership, multidisciplinary AMS (February 2016) and antitubercular therapy (ATT) stewardship programmes (June 2017) were established. Clinical pharmacists were introduced as core members of the programmes, responsible for the operational delivery of key stewardship interventions. Pharmacy-led audit and feedback monitored the appropriateness of antimicrobial prescriptions and compliance to AMS/ATT recommendations. Between February 2016 and January 2017, 56% (742/1326) of antimicrobial prescriptions were appropriate, and 54% (318/584) of recommendations showed compliance. By the third year of the AMS, appropriateness increased to 80% (1752/2190), and compliance to the AMS recommendations to 70% (227/325). The appropriateness of ATT prescriptions increased from a baseline of 61% (95/157) in the first year, to 72% (62/86, June 2018–February 2019). The compliance to ATT recommendations increased from 42% (25/60) to 58% (14/24). Such a model can be effective in implementing sustainable change in low- and middle-income countries (LMICs) such as India, where the shortage of infectious disease physicians is a major impediment to the implementation and sustainability of AMS programmes.
Highlights
Antimicrobials constitute around one third of the health budgets in developing countries, where the burden of infectious diseases is immense [1]
A study conducted on the use of antibiotics in 76 countries over 16 years reported that antibiotic consumption rates in low- and middle-income countries (LMICs) are on par to rates observed in highincome countries [2]
We describe how a multidisciplinary antimicrobial stewardship (AMS) programme in a teaching hospital in South India evolved to be driven by clinical pharmacists, and in the process created new opportunities for clinical pharmacy
Summary
Antimicrobials constitute around one third of the health budgets in developing countries, where the burden of infectious diseases is immense [1]. The American Society of Health-System Pharmacists recognises that pharmacists have a responsibility to take prominent roles in AMS and participate in the infection prevention and control programmes of healthcare organisations [11]. Clinical pharmacists have expert knowledge of drugs which can be utilised to rationalise antibiotic use and prevent the emergence of resistance. In countries such as the United Kingdom, a specialised antibiotic pharmacists’ role in AMS includes providing expert advice on the use of antibiotic management, education on antibiotic prescribing for health care professionals, to act as a liaison between pharmacy and microbiology departments, formulary enforcement, developing and maintaining antibiotic guidelines, monitoring and feedback of antibiotic use, co-developing antibiotic policy, and antibiotic serum level monitoring and dosing [12]. In the United States, the role of clinical pharmacists have expanded over time, and they are considered core members of the AMS team and assist in appropriate antibiotic utilization [13]
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