Snapshot of antimicrobial stewardship programs in the hospitals of Pakistan: findings and implications

Abstract

Objective We are unaware of the extent of antimicrobial stewardship programs (ASPs) among hospitals in Pakistan, which is a concern given the population size, high use of antibiotics across sectors and increasing antimicrobial resistance (AMR) rates. Consequently, we sought to address this by undertaking a comprehensive survey. Method In this cross-sectional observational study in Punjab, an instrument of the measure was developed based on health care facility characteristics and ASPs after an extensive literature review . The questionnaire was circulated by mail or through drop off surveys to medical superintendents or directors/heads of pharmacy departments of hospitals. Results Out of 254, a total of 137 hospitals fully completed the questionnaire - 11 primary, 65 secondary, 46 tertiary and 15 specialized hospitals. The use of antimicrobial prescribing guidelines (68.7%), provision of infectious diseases consultation services (66.4%), clinical pharmacy service (65.7%), use of drug and therapeutics committees to approve antimicrobial prescribing (65.5%), regular audit by doctors on antimicrobial prescribing (54.1%) and use of a restricted formulary for antimicrobial (50.4%) were the most common ASPs. However, most of these activities were only somewhat or moderately successful. Whereas, electronic antimicrobial prescribing approval systems (15.3%), using a sticker to notify prescribers regarding the need to obtain approval for the antimicrobial prescribed (16.1%) and participation in the national antimicrobial utilization surveillance program (19.7%) were only seen in a few hospitals. Conclusion Study inferred that there are inadequate ASPs in the hospitals of Pakistan. A multidisciplinary approach, clinical leadership and availability of motivated and trained individuals are essential elements for the success of future ASPs.

Impact of Culture Sensitivity Reports on the Pattern of Antibiotics use and Cost of Therapy: A Prospective Observational study

“…Our results suggest the urgent need to develop guidelines as well as instigate antimicrobial stewardship programmes (ASPs) in this hospital to reduce the unnecessary use of antibiotics [65]. This also applies to other hospitals in Pakistan to help improve future antimicrobial prescribing in hospitals [66].…”

An antibiotic stewardship program in a surgical ICU of a resource-limited country: financial impact with improved clinical outcomes

“…The findings of the current study from tertiary care private sector teaching hospital in Karachi, Pakistan encourages the public sector hospitals to identify key champions to engage with government and policymakers to ensure effective support for and scale-up of interventions in the public sector hospitals to implement the ASP program [40]. To optimize antimicrobial use and establish effective ASP in LMICs settings first there needs to be equitable access to standardized antimicrobials across the entire healthcare pathway [41].…”

“… SICU surgical intensive care unit, ASP antibiotic stewardship program, Obs/gyn obstetrics and gynecological, ENT ears, nose and throat, ns not significant * Mean (SD) **Comorbidities were coded from the World Health Organization, International Classification of Diseases, 10 th revision, Clinical Modification (ICD-10) [ 23 ] …”

“…**Comorbidities were coded from the World Health Organization, International Classification of Diseases, 10 th revision, Clinical Modification (ICD-10) [ 23 ]…”

“…Recently published studies have shared the high frequency of inappropriate antibiotics use [22] and ineffective ASPs in the hospitals of Pakistan with an inadequate multidisciplinary approach and lack of involvement of clinical leadership and trained individuals [23]. Furthermore, considerable challenges and resistance are faced in the actual clinical implementation of ASPs.…”