Antibiotic Stewardship

Indonesia
December 19, 2012

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 Antibiotic Stewardship

 Optimal, safe antimicrobial usage in order to improve

patient outcomes and
 Minimize the emergence of resistance.
 A key component to reducing unnecessary healthcare
costs without negatively impacting the quality of care
 Antibiotic stewardship program

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 Is there a problem with antibiotic use?
What are those?

 Is the antibiotic formulary (list) austere (manageable)?

 How is the new antibiotic approved?
 How do you restrict certain antibiotics?
 What are they?
 Who approves the use?
 How do you monitor the restricted antibiotics?

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 Who reviews the culture results?
 Antibiotic Use

What are you doing about it?

What to do next to improve?

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 Antibiotic Stewardship
 Interdisciplinary approach
– An individual
– An informal group
– A committee
 Set the goal and agenda
 Meet regularly
 Communicate (share) the review with the entire
hospital
 Monitor progress

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Antibiotic Stewardship Program

 Guidelines and clinical pathways

 Antimicrobial order forms
 Clinical Interventions
 Formulary Restrictions
 Parenteral to Oral Therapy Conversion
 Quality Assurance

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Antibiotic Stewardship Committee

 Membership
– Infection specialist or clinical microbiologist
– A pharmacist (s)
– A physician (surgeon, orthopedist, etc.)
– A nurse (s)
– A laboratory personnel
– A quality and patient safety personnel

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– Others
 Antibiotic Stewardship Committee
6

 Reviews the antibiotic formulary regularly

 Reviews monthly usage of parenteral antibiotics
 Restriction of certain antimicrobial agents (examples)
 Restrict quinolones (levofloxacin, etc.) due to the
rising resistance and their implication in more
virulent clostridium difficile epidemic.
 Prevent treating asymptomatic bacteriuria or chest x-ray
without clinical evidence of pneumonia
 Automatic stop of antibiotic to prevent over-usage,
 Clinical pharmacist’s* review of culture results to adjust antibiotic
therapy within 2-3 days

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* Or a microbiologist, IP, etc.
 Example Agenda

 Review of the entire monthly IV antibiotic usage - all

 Drug Utilization Review of Antibiotic X (recently
restricted) - pharmacy
 C. difficile rate review[ - infectious disease and lab.
 Update antibiotic order set for sepsis syndrome – ID
 Remove an automatic urine culture from the laboratory
menu as a reflex of abnormal urinalysis - ID
 MDROs trend - laboratory

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 Antibiogram

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 Q and A

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