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Published on: August 30, 2018
Revised hospital antibiotic formulary reduces antimicrobial consumption and promotes a shift towards narrow-spectrum
Taketo Zamami1,2, Hideo Shiohira1,2, Masashi Nakamatsu2,3
1Department of Pharmacy, University of the Ryukyus Hospital, Okinawa, Japan.
Insights
A revised antibiotic formulary significantly reduced overall antibiotic use in a university hospital. The study also observed an increase in the prescription of narrow-spectrum antibiotics for both inpatient and outpatient care.
Area of Science:
- Infectious Diseases
- Pharmacology
- Hospital Administration
Background:
- Japan's national action plan targets a 50% reduction in specific oral antibiotic use by 2020.
- Antimicrobial resistance (AMR) is a significant global health concern requiring strategic interventions.
- University hospitals play a crucial role in implementing and evaluating AMR containment strategies.
Purpose of the Study:
- To assess the impact of a revised antibiotic formulary on oral antibiotic prescribing patterns.
- To evaluate changes in antibiotic use for both inpatient and outpatient settings.
- To determine the effectiveness of formulary revisions in curbing antibiotic consumption.
Main Methods:
- A retrospective before-and-after study design was employed.
- Antimicrobial consumption data from 2013 to 2018 were analyzed.
- Data were extracted from electronic medical records and measured as defined daily doses per 1000 patient-days.
Main Results:
- Total oral antibiotic use density decreased from 117.95 to 75.42 (in-hospital) and 239.83 to 193.88 (out-hospital) between 2013 and 2018.
- Significant reductions were observed in cephalosporin, macrolide, and fluoroquinolone use.
- Penicillin prescriptions increased by 71.31% (in-hospital) and 42.72% (out-hospital).
Conclusions:
- The revised hospital antibiotic formulary effectively reduced overall antibiotic consumption.
- The formulary revision promoted a shift towards narrower-spectrum antibiotic use.
- These findings support the utility of formulary management in combating antimicrobial resistance.
Background:
In Japan, the national action plan to adress antimicrobial resistance problems aimed to reduce the use of oral cephalosporins, quinolones, and macrolides per day per 1000 inhabitants by 50% from the levelin 2013 by 2020. The aim of this study was to evaluate the effects of a revised antibiotic formulary on in- and out-hospital oral antibiotic prescribing practices at a 600-bed university hospital.
Method:
A retrospective before-and-after comparison study was conducted. All antimicrobial consumption data in the reviewed classes from 1 January 2013 to 31 December 2018, were extracted from the hospital database's electronic medical records. The data were measured in the defined daily dose and antibiotic use density (defined daily dose per 1000 patient-days).
Results:
The total oral antibiotic use densities for in-hospital prescriptions in 2013 and 2018 were 117.95 and 75.42, respectively, and 239.83 and 193.88, respectively, for out-hospital prescriptions. From 2013 to 2018, antibiotic use densities of second- and third-generation cephalosporins, macrolides and fluoroquinolones for in-hospital prescriptions changed annually by -49.00%, -92.67%, +0.49% and -48.19%, and out-hospital prescriptions of these antibiotics changed by +76.69%, -86.37%, -16.29% and -51.75%, over the same period. Penicillin prescriptions increased by 71.31% for in-hospital and 42.72% for out-hospital prescriptions over this period.
Conclusions:
The revised hospital antibiotic formulary reduced total antibiotic consumption and increased the use of narrow-spectrum antibiotics for both in- and out-hospital prescriptions.
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