Current research demonstrates that ASPs can decrease total antibiotic consumption in hospitals by 19% and restrict the usage of certain antimicrobials by 27%. However, the effectiveness of ASPs in low- and middle-income countries (LMICs), where antimicrobial use is disproportionately high compared to high-income countries (HICs), remains underexplored.
In a recent study by Zay et al (2023), the authors synthesised existing evidence regarding the connection between ASPs and global antibiotic consumption. They gathered data from multiple sources, including PubMed, Web of Science, and Scopus databases, covering studies from 1 August 2010, to 1 August 2020. Additional studies were incorporated from the references of previous systematic reviews.
The study selection criteria included original research studies exploring the impact of ASPs on antimicrobial consumption across different healthcare settings and income levels. Animal and environmental studies were excluded. The researchers followed the Preferred Reporting Items in Systematic Reviews and Meta-Analyses guidelines and used multilevel random-effects models to assess the association of targeted ASPs with antimicrobial consumption.
They also employed the Effective Public Health Practice Project quality assessment tool to evaluate study quality. The main outcome measures included the proportion of patients receiving antibiotic prescriptions and defined daily doses per 100 patient-days.
The study encompassed 52 research papers, involving a total of 1 794 889 participants. Among these studies, 40 were conducted in HICs, and 12 in LMICs. The analysis revealed that ASPs were linked to a 10% reduction in antibiotic prescriptions and a 28% decrease in antibiotic consumption (rate ratio, 0.72; 95% CI, 0.56-0.92).
Notably, ASPs were associated with a 21% reduction in antibiotic consumption in paediatric hospitals and a 28% reduction in World Health Organization (WHO) Watch group antibiotics. These findings are promising, suggesting that ASPs are effective in reducing antibiotic consumption in both hospital and non-hospital settings. However, the assessment of ASPs’ impact in resource-limited settings remains limited, underscoring the need for further research on strategies to curtail antibiotic use in LMICs.
The meta-analysis results indicate that ASPs successfully reduced antibiotic prescriptions by 10% and lowered antibiotic consumption rates by 28%. This reduction was observed across various antibiotic classes, except for penicillin, which are not always targeted by ASP interventions and, in some cases, are even encouraged.
ASPs also played a crucial role in reducing antibiotic consumption of WHO Watch list antibiotics, which are at a high risk of promoting bacterial resistance. Given the growing use of Watch antibiotics worldwide, these results offer hope that protecting these drugs through appropriate ASPs is attainable.
Subgroup analyses revealed that ASPs were particularly effective in reducing antibiotic prescriptions in paediatric care, where antibiotic use is known to be notably high. In contrast, prescriptions for other patient groups, such as inpatients, outpatients, and nursing home residents, were generally smaller and often not statistically significant. Additionally, the analysis indicated that ASPs in HICs were associated with a 6% reduction in antibiotic prescriptions, echoing previous findings.
A study conducted in 47 small hospitals in South Africa did not report quantitative estimates of consumption, but it found that introducing pharmacist expertise in a setting with limited infectious disease resources had substantial consequences for antibiotic use and consumption. While the present study tried to also analyse the outcome of specific ASP components, the currently available data are not sufficient to assess the relative effectiveness of each component.
Nevertheless, the study identified only four studies conducted in LMICs, raising concerns about the generalisability of these results. The limited number of studies from LMICs and the mixed findings emphasise the need for additional research on the implementation of ASPs in such settings. Challenges in LMICs include limited access to antibiotics, scarce diagnostics, and weak adherence to treatment, making it imperative to explore how to implement ASPs effectively without compromising the quality of patient care. Although this study aimed to analyse the outcomes of specific ASP components, the current data are insufficient to assess the relative effectiveness of each component.
In conclusion, ASPs have demonstrated their ability to reduce antibiotic consumption, not only in hospital settings but also in non-hospital environments. These findings are especially encouraging as they extend to WHO Watch group antibiotics with a high risk of resistance.
Given that overuse and misuse of antibiotics are the primary drivers of AMR, reducing antimicrobial consumption through ASPs is a critical step toward mitigating this global health threat.
Zay Ya K, Win PTN, Bielicki J, Lambiris M, Fink G. Association Between Antimicrobial Stewardship Programs and Antibiotic Use Globally: A Systematic Review and Meta-Analysis. JAMA Netw Open, 2023;6(2):e2253806. doi:10.1001/jamanetworkopen.2022.53806.