Sustained reduction in third-generation cephalosporin usage in adult inpatients following introduction of an antimicrobial stewardship program in a large urban hospital in Malawi

Clinical Infectious DiseasesLester R, Haigh K, Wood A, et al. | February 17, 2020

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For severe infection, third-generation cephalosporins (3GC) remain the first-choice empiric antibiotic in many sub-Saharan African hospitals. As in Malawi, there is limited availability of alternatives for severe infection, it is imperative to determine strategies to prevent the spread of 3GC-resistance. Researchers here described antimicrobial stewardship (AMS) intervention introduced by them in Queen Elizabeth Central Hospital in Blantyre. A smartphone prescribing application and regular point-prevalence surveys with prescriber feedback were included in the intervention. The antimicrobial stewardship approach was successfully introduced in Malawi. They observed a reduction in the proportion of antibiotic prescriptions for a 3GC from 193/241 (80.1%) to 177/330 (53.6%) (percentage decrease 26.5%) with no change in case-fatality rate. As per cost analysis, annual savings of US$15,000 was achieved. By concentrating on pragmatic interventions and simple aims, they illustrated the feasibility, acceptability, and cost-saving of a stewardship program where resources are short. In doing so, a suitable starting point was provided for the expansion of AMS interventions in this and other low-income settings.

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