Evaluation of a Hospital-Based Post-Prescription Review and Feedback Pilot in Kathmandu, Nepal

Area of Science:

• Global Health
• Infectious Diseases
• Pharmacology

Background:

• Antimicrobial resistance (AMR) poses a significant threat, necessitating capacity building in low- and middle-income countries (LMICs).
• Antimicrobial stewardship programs, including post-prescription review and feedback (PPRF), are crucial for combating AMR.
• Limited data exist on the effectiveness of PPRF programs in LMIC healthcare settings.

Purpose of the Study:

• To evaluate the effectiveness of an adapted PPRF program in a hospital in Kathmandu, LMIC.
• To assess changes in antibiotic utilization and prescribing practices following PPRF implementation.
• To determine the feasibility of PPRF in resource-limited settings.

Main Methods:

• An adapted PPRF program was implemented in medicine, surgery, and obstetrics/gynecology wards.
• Seven physician champions were trained to conduct patient chart reviews and provide feedback.
• Patient chart data were analyzed pre- and post-intervention for antibiotic days of therapy (DOT), course duration, justification, and guideline adherence.

Main Results:

• Significant decreases were observed in days of therapy for aminoglycoside (P < 0.001) and cephalosporin (P < 0.001) antibiotics.
• The medicine ward showed increased justified antibiotic use (P = 0.02), de-escalation (P < 0.001), and adherence to guidelines (P = 0.02).
• Physician champions' recommendations were followed in 78.3% of cases, indicating successful intervention.

Conclusions:

• Post-prescription review and feedback (PPRF) can be successfully implemented in LMIC hospitals, even those lacking infectious disease specialists.
• The adapted PPRF program led to significant improvements in antibiotic utilization and rational prescribing.
• Further adaptation and training are needed to optimize antibiotic stewardship in LMICs.