Impact of a clinical pharmacist driven antimicrobial stewardship program at a tertiary care hospital in the United Arab Emirates
Main Article Content
Keywords
antimicrobial stewardship, clinical pharmacist, tertiary care hospital, United Arab Emirates, antimicrobial utilisation, antimicrobial cost
Abstract
Background: This study aimed to evaluate the influence of an antimicrobial stewardship program (ASP) driven by a clinical pharmacist on antimicrobial use,cost, and susceptibilities at a tertiary care hospital in the United Arab Emirates (UAE). Methods: A single-centre quasi-experimental design was employed, comparing pre-intervention and post-intervention phases of clinical pharmacist-driven ASP. The intervention involved the integration of clinical pharmacists into the ASP team, participating in medication reviews, providing prescriber education, and actively engaging in antimicrobial decision-making. Data were collected on quarterly antimicrobial utilisation, antimicrobial susceptibilities and antimicrobial cost. Results: Following the implementation of the clinical pharmacist-driven ASP, there was a significant reduction in ASP-focused antimicrobial utilisation, with a particular decline in the usage of broad-spectrum agents, Carbapenems, Fluoroquinolones, and Antifungals. Significant changes in the susceptibilities of some bacteria were noted. Significant decreases in antimicrobial expenditures were observed. Conclusion: The findings suggest that integrating clinical pharmacists into the antimicrobial stewardship program at the tertiary care hospital in the UAE substantially impacted optimising antimicrobial use. This model emphasises the crucial role of clinical pharmacists in promoting judicious antimicrobial prescribing practices, ultimately contributing to improved antimicrobial use and the prevention of antimicrobial resistance.
References
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26. Al-Ayed MZ. Parents’ knowledge, attitudes and practices on antibiotic use by children. Saudi J Med Med Sci. 2019;7(2):93.https://doi.org/10.4103/sjmms.sjmms_171_17
27. Kapoor G, Saigal S, Elongavan A. Action and resistance mechanisms of antibiotics: A guide for clinicians. J Anaesthesiol ClinPharmacol. 2017;33(3):300. https://doi.org/10.4103/joacp.joacp_349_15
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31. Kisuule F, Wright S, Barreto J, et al. Improving antibiotic utilization among hospitalists: A pilot academic detailing project with a public health approach. J Hosp Med. 2008;3(1):64-70. https://doi.org/10.1002/jhm.278
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thuoc-tai-Viet-Nam-580479.aspx
35. Alumran A, Hou XY, Sun J, et al. Assessing the construct validity and reliability of the parental perception on antibiotics (PAPA)scales. BMC Public Health. 2014;14(1):73. https://doi.org/10.1186/1471-2458-14-73
36. Okide CC, Grey-Ekejiuba O, Ubaka CM, et al. Parents’ Knowledge, Attitudes and Use of Antibiotics in Upper RespiratoryInfections in Nigerian Children. African Journal of Biomedical Research. 2020;23(2):213-20. https://doi.org/10.1093/tropej/fmt111
37. Harun GD, Haider R, Haque I, et al. Parental Knowledge, Attitudes, and Practices Regarding Antibiotic Use: A Cross-Sectional Study in Bangladesh. Infect Control Hosp Epidemiol. 2020;41(S1):s342–s342. https://doi.org/10.1038/s41598-024-52313-y
38. Al‐Saleh S, Abu Hammour K, Abu Hammour W. Influencing factors of knowledge, attitude, and practice regarding antibiotic use in children with upper respiratory tract infections in Dubai. J Eval Clin Pract. 2020 Feb 12;26(1):197–202. https://doi.org/10.1111/jep.13188
39. Wang J, Sheng Y, Ni J, et al. Shanghai Parents’ Perception And Attitude Towards The Use Of Antibiotics On Children: A Cross-Sectional Study. Infect Drug Resist. 2019;12:3259-7. https://doi.org/10.2147/idr.s219287
40. Abu Hammour K, Abu Farha R, Alsous M, et al. Evaluation of risk factors affecting parental knowledge and attitude toward antibiotic use in children with upper respiratory tract infections. Eur J Integr Med. 2018;17:107-1.
41. Shah NM, Rahim MA. Parental knowledge, attitudes, and practices (KAPs) on the use of antibiotics in children for upper respiratory tract infections (URTIs). Int J Pharm Pharm Sci. 2017;9(3):105-10.
2. McKinn S, Trinh DH, Drabarek D, et al. Drivers of antibiotic use in Vietnam: implications for designing community interventions.BMJ Glob Health. 2021;6(7):e005875. https://doi.org/10.1136/bmjgh-2021-005875
3. Nguyen LV, Pham LTT, Bui AL, et al. Appropriate Antibiotic Use and Associated Factors in Vietnamese Outpatients. Healthcare.2021;9(6):693. https://doi.org/10.3390/healthcare9060693
4. World Health Organization. Antibiotic resistance [Internet]. 2023 [cited 2023 Oct 6]. Available from: https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistancee
5. Perz JF. Changes in Antibiotic Prescribing for Children After a Community-wide Campaign. JAMA. 2002;287(23):3103. https://doi.org/10.1001/jama.287.23.3103
6. Aricò MO, Valletta E, Caselli D. Appropriate Use of Antibiotic and Principles of Antimicrobial Stewardship in Children. Children.2023;10(4):740. https://doi.org/10.3390/children10040740
7. Rouusounides A, Papaevangelou V, Hadjipanayis A, et al. Descriptive Study on Parents’ Knowledge, Attitudes and Practices on Antibiotic Use and Misuse in Children with Upper Respiratory Tract Infections in Cyprus. Int J Environ Res Public Health. 2011;8(8):3246-62. https://doi.org/10.3390/ijerph8083246
8. Togoobaatar G, Ikeda N, Ali M, et al. Survey of non-prescribed use of antibiotics for children in an urban community in Mongolia. Bull World Health Organ. 2010;88(12):930-6. https://doi.org/10.2471/blt.10.079004
9. Huang SS, Rifas-Shiman SL, Kleinman K, et al. Parental Knowledge About Antibiotic Use: Results of a Cluster-Randomized, Multicommunity Intervention. Pediatrics. 2007;119(4):698-6. https://doi.org/10.1542/peds.2006-2600
10. Pavydė E, Veikutis V, Mačiulienė A, et al. Public Knowledge, Beliefs and Behavior on Antibiotic Use and Self-Medication in Lithuania. Int J Environ Res Public Health. 2015;12(6):7002-16. https://doi.org/10.3390/ijerph120607002
11. Nga DTT, Chuc NTK, Hoa NP, et al. Antibiotic sales in rural and urban pharmacies in northern Vietnam: an observational study.BMC Pharmacol Toxicol. 2014;15(1):6. https://doi.org/10.1186/2050-6511-15-6
12. Larsson M, Kronvall G, Chuc N, et al. Antibiotic medication and bacterial resistance to antibiotics: a survey of children in a Vietnamese community. Tropical Medicine and International Health. 2000;5(10):711-1. https://doi.org/10.1046/j.1365-3156.2000.00630.x
13. Anh NTV, Bang NV, antibiotherapy in children with pneumonia admited into pediatric dipartment of Bach Mai hospital in 2006. Y Hoc TPHCM [Internet]. 2007 [cited 2023 Oct 6];11(4):94–99. Available from: https://yhoctphcm.ump.edu.vn/index.php?Content=ChiTietBai&idBai=9529
14. Esteireiro AS, Morais V, Henriques CJ, et al. Parents Knowledge and Attitudes Towards the use of Antibiotics in Patients within the Paediatric age Range. Pediatr Oncall. 2020;17(2).
15. Paredes JL, Navarro R, Watanabe T, et al. Knowledge, attitudes and practices of parents towards antibiotic use in rural communities in Peru: a cross-sectional multicentre study. BMC Public Health. 2022;22(1):459. https://doi.org/10.1186/s12889-022-12855-0
16. Salama RA, Bader KN, Rahmen AS, et al. Parents Knowledge, attitude and practice of antibiotic use for upper respiratory tract infections in children: a cross-sectional study in Ras Al khaimah, United Arab Emirates. Epidemiol Biostat Public Health. 2022;15(4).
17. General Statistics Office. Statistical Yearbook of Vietnam. Statistical Publishing House; 2021.
18. Alumran A, Hurst C, Hou XY. Antibiotics Overuse in Children with Upper Respiratory Tract Infections in Saudi Arabia: Risk Factors and Potential Interventions. Clinical Medicine and Diagnostics. 2012;1(1):8-16.
19. Alumran A, Hou XY, Hurst C. Assessing the overuse of antibiotics in children in Saudi Arabia: validation of the parental perception on antibiotics scale (PAPA scale). Health Qual Life Outcomes. 2013;11(1):39. https://doi.org/10.1186/1477-7525-11-39
20. Panagakou SG, Theodoridou MN, Papaevangelou V, et al. Development and assessment of a questionnaire for a descriptive cross – sectional study concerning parents’ knowledge, attitudes and practises in antibiotic use in Greece. BMC Infect Dis.2009;9(1):52. https://doi.org/10.1186/1471-2334-9-52
21. Yu M, Zhao G, Stålsby Lundborg C, et al. Knowledge, attitudes, and practices of parents in rural China on the use of antibiotics in children: a cross-sectional study. BMC Infect Dis. 2014;14(1):112. https://doi.org/10.1186/1471-2334-14-112
22. Lugova H, Ivanko O, Chumachenko T, et al. Parental knowledge, attitudes and practices regarding antibiotic use in children with upper respiratory infections in Ukraine. International Journal of Infectious Diseases. 2020;101:59.
23. Teck KC, Ghazi HF, Bin Ahmad MI, et al. Knowledge, Attitude, and Practice o Parents Regarding Antibiotic Usage in Treating Children’s Upper Respiratory Tract Infection at Primary Health Clinic in Kuala Lumpur, Malaysia. Health Serv Res Manag Epidemiol. 2016;3:233339281664372. https://doi.org/10.1177/2333392816643720
24. Levy Hara G, Kanj SS, Pagani L, et al. Ten key points for the appropriate use of antibiotics in hospitalised patients: a consensus from the Antimicrobial Stewardship and Resistance Working Groups of the International Society of Chemotherapy. Int J Antimicrob Agents. 2016;48(3):239-6. https://doi.org/10.1016/j.ijantimicag.2016.06.015
25. Al-Dossari K. Parental Knowledge , Attitude and Practice on Antibiotic Use for Upper Respiratory Tract Infections in Children.Majmaah Journal of Health Sciences. 2013 ;1(1):33-45. https://doi.org/10.18295/squmj.2021.21.02.019
26. Al-Ayed MZ. Parents’ knowledge, attitudes and practices on antibiotic use by children. Saudi J Med Med Sci. 2019;7(2):93.https://doi.org/10.4103/sjmms.sjmms_171_17
27. Kapoor G, Saigal S, Elongavan A. Action and resistance mechanisms of antibiotics: A guide for clinicians. J Anaesthesiol ClinPharmacol. 2017;33(3):300. https://doi.org/10.4103/joacp.joacp_349_15
28. Center for disease control and prevention. Be Antibiotics Aware: Smart Use, Best Care [Internet]. 2021 [cited 2023 Oct 6]. Available from: ttps://www.cdc.gov/patientsafety/features/be-antibiotics-aware.html
29. Grigoryan L, Burgerhof JGM, Haaijer-Ruskamp FM, et al. Is self-medication with antibiotics in Europe driven by prescribed use?Journal of Antimicrobial Chemotherapy. 2006;59(1):152-6. https://doi.org/10.1093/jac/dkl457
30. Tenover FC. Mechanisms of Antimicrobial Resistance in Bacteria. Am J Med. 2006 ;119(6):S3-S10.
31. Kisuule F, Wright S, Barreto J, et al. Improving antibiotic utilization among hospitalists: A pilot academic detailing project with a public health approach. J Hosp Med. 2008;3(1):64-70. https://doi.org/10.1002/jhm.278
32. Ministry of heath. Circular No. 05/2016/TT-BYT regulations on prescription in outpatient treatment [Internet]. 2016 [cited 2023 Oct 6]. Available from: https://thuvienphapluat.vn/van-ban/The-thao-Y-te/Thong-tu-05-2016-TT-BYT-ke-don-thuoctrong-dieu-tri-ngoai-tru-305126.aspx
33. Awad A, Eltayeb I, Matowe L, et al. Self-medication with antibiotics and antimalarials in the community of Khartoum State,Sudan. J Pharm Pharm Sci. 2005;8(2):326-31.
34. The Prime Minister of Vietnam. Decision No 1121/QĐ-TTG Approval of the national strategy for prevention and control of drug resistance in Vietnam for the period of 2023 – 2030 with a vision towards 2045 [Internet]. 2023 [cited 2023 Oct 6]. Available from: https://thuvienphapluat.vn/van-ban/The-thao-Y-te/Quyet-dinh-1121-QD-TTg-2023-Chien-luoc-quoc-gia-phong-chongkhang-
thuoc-tai-Viet-Nam-580479.aspx
35. Alumran A, Hou XY, Sun J, et al. Assessing the construct validity and reliability of the parental perception on antibiotics (PAPA)scales. BMC Public Health. 2014;14(1):73. https://doi.org/10.1186/1471-2458-14-73
36. Okide CC, Grey-Ekejiuba O, Ubaka CM, et al. Parents’ Knowledge, Attitudes and Use of Antibiotics in Upper RespiratoryInfections in Nigerian Children. African Journal of Biomedical Research. 2020;23(2):213-20. https://doi.org/10.1093/tropej/fmt111
37. Harun GD, Haider R, Haque I, et al. Parental Knowledge, Attitudes, and Practices Regarding Antibiotic Use: A Cross-Sectional Study in Bangladesh. Infect Control Hosp Epidemiol. 2020;41(S1):s342–s342. https://doi.org/10.1038/s41598-024-52313-y
38. Al‐Saleh S, Abu Hammour K, Abu Hammour W. Influencing factors of knowledge, attitude, and practice regarding antibiotic use in children with upper respiratory tract infections in Dubai. J Eval Clin Pract. 2020 Feb 12;26(1):197–202. https://doi.org/10.1111/jep.13188
39. Wang J, Sheng Y, Ni J, et al. Shanghai Parents’ Perception And Attitude Towards The Use Of Antibiotics On Children: A Cross-Sectional Study. Infect Drug Resist. 2019;12:3259-7. https://doi.org/10.2147/idr.s219287
40. Abu Hammour K, Abu Farha R, Alsous M, et al. Evaluation of risk factors affecting parental knowledge and attitude toward antibiotic use in children with upper respiratory tract infections. Eur J Integr Med. 2018;17:107-1.
41. Shah NM, Rahim MA. Parental knowledge, attitudes, and practices (KAPs) on the use of antibiotics in children for upper respiratory tract infections (URTIs). Int J Pharm Pharm Sci. 2017;9(3):105-10.
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Mar 26, 2025
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Impact of a clinical pharmacist driven antimicrobial stewardship program at a tertiary care hospital in the United Arab Emirates. Pharm Pract (Granada) [Internet]. 2025 Mar. 26 [cited 2025 Jun. 16];23(1):1-6. Available from: https://www.pharmacypractice.org/index.php/pp/article/view/3111
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How to Cite
1.
Impact of a clinical pharmacist driven antimicrobial stewardship program at a tertiary care hospital in the United Arab Emirates. Pharm Pract (Granada) [Internet]. 2025 Mar. 26 [cited 2025 Jun. 16];23(1):1-6. Available from: https://www.pharmacypractice.org/index.php/pp/article/view/3111