Tackling the antibiotic time-bomb

SA programme shows how antibiotic consumption can be significantly reduced

A pharmacist-driven antibiotic stewardship programme running at 47 Netcare hospitals across South Africa has demonstrated that a meaningful reduction in antibiotic usage can be achieved through a number of basic interventions.

The achievements of the programme were highlighted in a research paper recently published in Lancet Infectious Diseases on behalf of the Netcare multi-disciplinary antimicrobial stewardship teams. According to the authors, who included Dr Adrian Brink, Professor Guy Richards, Dr Dena van den Bergh and other local and international academic collaborators, the programme achieved an 18% reduction in the consumption of antibiotics by in-hospital patients at these Netcare hospitals.

“We are tremendously excited about the outcomes of this programme, the results are highly significant for antibiotic stewardship in this country, and have already caught the attention of the international medical fraternity,” says Van den Bergh, who is Netcare’s director of quality leadership.

“The misuse and overuse of antimicrobials is considered to be one of the most urgent health risks both locally and internationally. While the study was conducted within our private hospital group and did not include public sector facilities, it does show that it is possible to achieve much greater control of antibiotic usage in a setting with limited infectious diseases specialists,” Van den Bergh explains.

The antibiotic stewardship (ABS) programme, a coordinated programme designed to promote the appropriate use of antibiotics, and on which the results were based, was conducted at the Netcare facilities between October 2009 and September 2014. The programme initially involved pharmacists in monitoring the use of antibiotics across intensive care units and thereafter in general medical and surgical wards. It aimed to achieve at least a 10% reduction in antimicrobial consumption and to introduce an effective ABS programme to the hospitals within the Netcare group thorough a collaborative approach between pharmacists, clinicians and frontline nursing teams.

“The ABS programme introduced collaborative improvement methodology across multiple hospitals and focused on five targeted measures including interventions to reduce excessively long treatment regimes and protocols to ensure appropriate antibiotic treatment at the same time,” notes Van Den Bergh.

“We found that 39% of the pharmacists’ interventions were for cases where antibiotic treatment was for an excessive duration, and it was in this area that we were able to achieve the most meaningful reduction in this initial work.

Another article published in the Lancet Infectious Diseases, written by Professor David Muckert of the Department of Medicine at the University of KwaZulu-Natal and colleagues, had high praise for the antibiotic stewardship programme, saying that the organisers “are to be congratulated on their initiative and their results”.

“We are running out of ammunition and face the prospect of a post-antibiotic era in which simple infections will be untreatable,” the University of KwaZulu-Natal authors point out. “Reducing unnecessary prescriptions, limiting broad spectrum drugs to when absolutely necessary, and prudent use of drug combinations are crucial interventions.”

They add that the programme has shown that, with careful planning and the adoption of a few sequential interventions, it is possible to achieve a significant reduction in the prescription and use of antibiotics. They also point out that the changes achieved through the Netcare initiative were implemented by clinicians, pharmacists and nurses eager to learn antibiotic stewardship skills, showing that it is a “myth” that only infectious disease and microbiological specialists are required to achieve such success.

According to the initiators of the Netcare programme, the work has now been embedded in pharmacy practice within the Netcare hospitals and the initiatives are now a routine standard of care for all in-patients receiving antibiotics. “Sharing comparative tables and multiple graphs describing the progress of each hospital involved led to greater collaboration among the healthcare teams in Netcare hospitals to achieve optimal results,” they explain.

“[The findings] confirmed that antimicrobial stewardship is possible despite most of the participating hospitals never having practised stewardship before, the wide geographical distribution of the facilities, the large number of hospitals involved, and the necessity to coordinate the interventions throughout all hospitals simultaneously.”

Dr Richard Friedland, chief executive officer of the Netcare group, says that he is impressed with the results that have been achieved through the Netcare ABS programme, and commended the multi-disciplinary teams involved in its development and implementation.

“With antibiotic resistance posing a major threat to health, it is pleasing that Netcare is at the forefront of addressing this issue. The ABS initiative is an important one for the industry and it demonstrates just how much can be achieved by dedicated and committed individuals who work together to achieve a common goal,” concludes Friedland.