Decline in Antibiotic Use after Implementation of Restriction Program at Eka Hospital, Pekanbaru, Riau

Martin Susanto¹, Puput OktamiQanti¹, Dewi Anggraini²,

Winda Gusti Enda²

¹⁾Masters Program of Public Health, Universitas Indonesia

²⁾Eka Hospital, Pekanbaru

ABSTRACT

Background: Antimicrobial agents are among the most frequently and inappro­priate­ly prescribed medications worldwide. Broad evidence indicates that approximately 64% of all hospitalized patients receive antibiotic drugs during their hospital stay. It has been reported that more than half of antibiotics may be in­appro­pri­ate­ly prescribed. With the high volume of broad spectrum antibiotics prescribed, there may be severe con­se­quences if simple management of pres­cribing habits is not initiated. Unnecessary use of antibiotics can contribute to the deve­lopment of antimicrobial resistance leading to possible development of suprainfections. This study aimed to examine the decline in an­ti­­biotics use after implementation of restriction pro­gram at Eka Hospital, Pekan­baru, Riau.

Subjects and Method: This was a quasi experiment before and after with no control design. This study was conducted at Eka Hospital, Pekanbaru, Riau on January 2017 to September 2018. A sample of in-patient was selected for this study by total sampling. The sample covered before restriction program (January to September 2017) and after res­triction program (October 2017 to September 2018). The dependent variable was quantity of antibiotic use rated in units DDD100 (defined daily dose). Antibiotics that are restructured are third-line antibiotics whose use must be controlled and deter­min­ed by the antimicrobial resistance control (PPRA), namely meropenem, doripenem, imi­pe­nem, vancomycin, linezolid, cefepime, tigecycline and amikacin. The independent va­ri­able was antibiotics restriction program. The data were collected by electronic medical record.

Results: There was an average decrease in DDD100 (in parenthesis) from previous year to restriction program has been effective, including six antibiotics that were res­trai­ned, namely meropenem (3.39 to 2.71), doripenem (0.43 to 0.08), imipenem (29 to 0.04), cefepime (1.53 to 0.28), amikacin (1.33 to 0.86), and tigecycline (0.71 to 0.58). There was an increase in vancomycin (0.27 to 0.40), and there was no linezolid pres­crip­tion from 2017 to 2018. Anti­bio­tics included meropenem (p=0.039), imipenem (p= 0.020) doripenem (p= 0.003) and cefepime (p= 0.001) were statiscally significant with decrease quantity of antibiotic use.

Conclusion: Antibiotics restriction program is effective to reduce unnecessary use of an­tibiotics. Altering antibiotics prescription practices through guideline development, res­tricting an­tibiotic usage through PPRA, and narrowing the spectrum of antibiotics have all shown vary­ing degrees of effectiveness.

Keywords: antibiotics stewardship program, restriction, DDD

Correspondence: Martin Susanto. Masters Program of Public Health, Universitas Indo­nesia.

Email: susanto.martin@gmail.com. Mobile: 0811153642.

DOI: https://doi.org/10.26911/theicph.2019.04.44

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