Stewardship Programs May Reduce Antibiotic Prescriptions, Consumption

Antimicrobial resistance (AMR) could have the same disease burden as HIV and malaria combined. AMR was estimated to cause 4.95 million deaths in 2019, and by 2050, could result in 10 million deaths globally, according to a study published in JAMA Network Open.

Antimicrobial stewardship programs (ASPs), which aim to delay AMR, were associated with a 10% reduction rate in antibiotic prescriptions. Further, antibiotic consumption rates decreased by 28%, according to the study.

“ASPs appeared to be effective in reducing antibiotic consumption in both hospital and nonhospital settings,” the study authors wrote. “Reducing antimicrobial consumption through ASPs should thus contribute toward reducing the risk of AMR.”

AMR is largely driven by the overuse and misuse of antibiotics, and low- and middle-income countries (LMICs) have much higher use of antibiotics and antimicrobials compared to high-income countries (HICs), according to the study.

ASPs were created so different settings could better utilize antimicrobials, ensure patient safety, and allow patients extra costs for antibiotics. Previous research suggests that ASPs can reduce individual antibiotic consumption by 19% and reduce their administration in the hospital setting by 27%.

Investigators conducted the study to provide updated data on the association between ASPs and antibiotic consumption. They also estimated how different classes of antibiotics are used in various health care settings and across different income levels.

The meta-analysis included 1,794,889 participants from 52 studies. Data were gathered from PubMed, Web of Science, and Scopus databases between August 2010 and August 2020. The main outcome measured the proportion of patients given a defined daily dose of an antibiotic prescription per 100 patient-days.

Investigators then stratified their findings across subgroups, including HICs and LMICs, study settings such as primary care practice and pediatric hospital, patient settings (e.g., outpatient), antibiotic restriction, and World Health Organization (WHO) Access, Watch, and Reserve (AWaRe) classification antibiotics 2019.

ASPs were associated with decreased antibiotic consumption and prescriptions across LMICs and HICs, according to the study. The investigators observed a 21% decrease in antibiotic consumption across pediatric hospitals and a 28% reduction in antibiotics on the WHO Watch list of antibiotics.

Additionally, antibiotic consumption in LMICs declined by 30%, on average, although investigators observed no reduction in outpatients prescribed antibiotics in the hospital setting. Further, decision support tools such as ASPs were associated with a 16% reduction in antibiotic prescriptions.

The study contains some limitations. First, the investigators cannot confirm that ASPs have a causal effect on antibiotic prescription or consumption rates. Additionally, the lack of studies looking at ASPs on LMICs limits the ability to accurately assess the benefits of ASP on LMIC compared to HIC, nor did it assess the impact of stewardship programs on the environment.

The data on the topic are still limited and investigators cannot prove a causal relation between ASPs and reduced prescriptions.

“Pragmatic randomized clinical trials of ASPs explicitly linking appropriateness of antibiotic utilization to resistant bacterial prevalence as an outcome should therefore be a key research priority,” the study authors wrote in the paper.

Reference

Ya K, Win P, Bielicki J, et al. Association Between Antimicrobial Stewardship Programs and Antibiotic Use Globally. Accessed February 10, 2023. JAMA Netw Open. 2023;6(2):e2253806. doi:10.1001/jamanetworkopen.2022.53806