Related Experiment Video
Updated: Nov 12, 2025
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Decreasing antibiotic over-use by implementation of an antibiotic stewardship programme in preterm neonates in
Anitha Kommalur1, Vidyalakshmi Baddadka1, Sahana Devadas1
1Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute (BMCRI), Bengaluru, Karnataka, India.
Insights
A quality improvement initiative significantly reduced antibiotic use in preterm neonates by 65% in a resource-limited setting. This antibiotic stewardship program proved safe and effective, decreasing over-prescription without increasing sepsis or mortality.
Area of Science:
- Neonatal Intensive Care
- Antibiotic Stewardship
- Quality Improvement Initiatives
Background:
- Antibiotic overuse in neonatal sepsis is a critical issue, linked to adverse outcomes.
- Current antibiotic prescribing rates in neonates are unacceptably high, particularly in resource-limited settings.
Purpose of the Study:
- To decrease antibiotic over-prescription in preterm neonates.
- To implement and evaluate an antibiotic stewardship program utilizing a quality improvement (QI) initiative.
Main Methods:
- A QI initiative was implemented in a neonatal intensive care unit (NICU) in a resource-limited setting.
- The initiative involved a 1-month baseline, 3 months of Plan-Do-Study-Act (P-D-S-A) cycles, and a 2-month sustainment phase.
- Antibiotic usage was measured as days of therapy (DOT)/1000 patient days.
Main Results:
- Antibiotic usage decreased by 65%, from 1464 DOT/1000 patient days to 442 DOT/1000 patient days over 3 months.
- Key interventions included defining conditions for no antibiotics, revising antibiotic policy, and de-escalation strategies.
- No increase in culture-positive sepsis or mortality was observed.
Conclusions:
- A tailored antibiotic stewardship program, implemented via a QI initiative, effectively and safely reduced antibiotic use in preterm neonates.
- This approach is particularly valuable in resource-limited settings for optimizing antibiotic prescribing.
Background:
Antibiotics play a critical role in neonatal sepsis but excessive use is associated with adverse outcomes and the current prescribing rates of antibiotics are unacceptably high.
Aim:
To reduce antibiotic over-use in preterm neonates by implementing an antibiotic stewardship programme using a quality improvement (QI) initiative.
Methods:
This study was conducted at a neonatal intensive care unit in a resource-limited setting. The reasons for antibiotic over-use were analysed and an antibiotic stewardship programme was implemented by using a QI initiative. The duration of the QI was a 1-month baseline phase followed by 3 months of implementation which was undertaken in the form of Plan-Do-Study-Act (P-D-S-A) cycles. The sustainment phase was observed for 2 months. All neonates admitted to the preterm unit were included. The outcome measure was the antibiotic usage expressed as days of therapy (DOT)/1000 patient days.
Results:
In the baseline phase, DOT/1000 patient days was 1464 which fell to 706, 511, and 442 DOT/1000 patient days, respectively, over 3 months, resulting in a 65% reduction in antibiotic usage. This was achieved by a combination of efforts directed towards defining the conditions for no antibiotics, revising existing antibiotic policy, stopping orders at 48 hours, de-escalation to the narrowest spectrum antibiotic, stopping prophylactic antifungal agents and limited use of broad-spectrum antibiotics. The results were achieved without an increase in culture-positive sepsis or mortality.
Conclusions:
Implementation of a tailored antibiotic stewardship programme through a QI initiative was effective and safe in reducing antibiotic use in preterm neonates in a resource-limited setting.
Abbreviations:
AIIMS, All India Institute of Medical Sciences; DOT, days of therapy; HIC, high-income countries; ICMR, Indian Council of Medical Research; LMIC, low- to middle-income countries; LOS, late-onset sepsis; NICU, neonatal intensive care unit; NNF, National Neonatology Forum; P-D-S-A, plan-do-study-act; QI, quality improvement; SNCU, Special newborn care unit.
Related Concept Videos
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
00:57Antibiotic Selection
01:28Antimicrobial Effectiveness
01:30Development of Antibiotic Resistance
01:22Pharmaceutical Alternatives: Stability-Related Therapeutic Nonequivalence