Pharmacy Researcher Studies, Implements Antimicrobial Stewardship Program in South Africa

Debra Goff, PharmD

Until recently, available data on antimicrobial stewardship programs in South Africa was scarce. But a pharmacist-driven antibiotic stewardship program in a South African hospital has seen an 18 percent reduction in antibiotic consumption, demonstrating that such programs can work in settings where expertise and resources are limited, according The Ohio State University College of Pharmacy’s Debra Goff, PharmD. Findings by Goff and her South African colleagues were recently published in The Lancet Infectious Diseases.

Antimicrobial stewardship (AMS [DG1]) promotes the appropriate use of antimicrobials (including antibiotics). It seeks to improve patient outcomes, reduce antimicrobial resistance, and decrease the spread of infections caused by multidrug-resistant organisms.

This study, focused on Netcare Hospitals, a private network with 47 urban and rural facilities across South Africa. Most of the hospitals were had not previously involved in an AMS program. The study was implemented from October 2009 through September 2014.

Researchers focused on preventing long antibiotic treatment courses and using antibiotics with overlapping spectrums of activity at once. The team used process measures that could contribute to over-prescription of antibiotics. Pharmacists recorded interventions and provided monthly reports to the project manager, who provided monthly consumption data and individualized goals.

The effect on antibiotic consumption was assessed with the WHO index of defined daily doses per 100 patient–days. The AMS program led to a reduction in antibiotic-defined daily doses per 100 patient–days from 101·38 in the pre-implementation phase to 83·04 in the post-implementation phase, thus showing that health-care facilities with limited infectious diseases expertise can achieve substantial returns through pharmacist-led antimicrobial stewardship programs and by focusing on basic interventions.

Other authors of the study include Adrian J Brink, MD; Angeliki P Messina, BPharm; Charles Feldman, DSC; Guy A Richards, PhD; Piet J Becker, PhD; Karri A Bauer, PharmD; Dilip Nathwani, MBChB;  and Dena van den Bergh, PhD on behalf of the Netcare Antimicrobial Stewardship Study Alliance.