Background and importance Antimicrobial stewardship programmes (ASPs) aim to optimise antimicrobial prescriptions, enhancing clinical outcomes, minimising antimicrobial resistance and improving the quality and safety of patient care. Guidelines recommend a multidisciplinary team but many hospitals do not have infectious disease (ID) physician support.

Aim and objectives To analyse the effectiveness of a pharmacist led ASP in a hospital without an ID physician, with special focus on indicators of the hospital use of antimicrobial agents based on consumption.¹

Material and methods A pharmacist led ASP was performed in a 200 bed hospital from 1 January to 30 June 2019.

1. The ASP was presented to the hospital physicians through face to face sessions.

2. To improve the prescription of antibiotics, we revised prophylaxis and antibiotic therapy in management protocols and developed a guideline with local antimicrobial recommendations.

3. Clinical sessions were held on different pathologies included in the ASP.

4. Information about antimicrobial consumption rate was provided to physicians.

In addition, the pharmacist performed a daily review of all patients who had a course of antibiotics during their hospital admission, through an electronic prescription programme. Recommendations were made to physicians related to antimicrobial spectrum, dose adjustment, stopping longer courses of antibiotics, interactions, allergies and other.

The consumption of defined daily dose (DDD)/1000 patient days was taken from the first half of 2019 and compared with the same period the previous year.

Results A total of 248 recommendations were recorded. The global consumption of antibiotics was reduced from 931 DDD/1000 patient days in the first half of 2018 to 747.9 DDD/1000 patient days in 2019 (−19.7%). Carbapenem use was reduced by 41.3% DDD (21.3 vs 12.5 DDD/1000 patient days). With regard to quinolones, consumption was reduced from 192.7 to 125.5 DDD/1000 patient days (−34.9%). There was a significant decrease in consumption of systemic antifungals of 42.9% (35.9 vs 20.5 DDD/1000 patient days). The ratio (cloxacilin+cefazolin)/anti-MRSA agents increased (1.3 vs 1.8).

Conclusion and relevance A pharmacist led ASP achieved a reduction in consumption of antibiotics, especially carbapenem and quinolones. In the absence of support and oversight from an infectious disease physician, pharmacists could be key in the improvement in the use of antibiotics.

References and/or acknowledgements 1. Gutiérrez-Urbón JM, Gil-Navarro MV, Moreno-Ramos F, et al. Indicadores del uso hospitalario de antimicrobianos basados en el consumo. Farm Hosp 2019;43:94–100.

No conflict of interest.