Antibiotic Use, Cost, and Consumption in Tertiary Hospitals in Lebanon: A Comparative Study Before and After an Implementation of Antibiotic-Restriction Program (ARP)

Abstract

Aims: To compare the antibiotic use, cost, and consumption before and after an implementation of an antibiotic-restriction program (ARP) in governmental hospitals setting in Lebanon. Study Design: A retrospective cohort study on hospitalized patients who were prescribed antibiotics prior to, and after the application of the ARP, was conducted over a three month period, between March 2013 and June 2013. Methodology: The studied population included patients on antibiotic therapy. The sample size that was enrolled was equal to 612 patients prior to ARP and 606 patients after ARP. Results: The average age of the patients was 34.6±23.5 years, 55.6% of whom were females, and 79.2% had no comorbidity. Respiratory diseases, and gynecological surgeries motivated the antibiotics prescriptions. The physicians prescribed combinations of intravenous antibiotics in 91% of the cases. The most frequently ordered antibiotics were second, third- generation cephalosporins, and penicillin derivatives. After ARP, the rate of restricted antibiotic use decreased by 11% (P<.0001), while the use of gentamicin increased with a potential for increased rates of nephrotoxicity and ototoxicity; Prior to and after the ARP, a microbiological exam was done in 12.6% of cases, and 67.3% of the cases of prescribed antibiotics were sensitive. The expenditure of all, and restricted antibiotics decreased by 22.3% and 9% respectively. The cost savings were US$ 8099 per month. The compliance with the ARP by prescribers was very high (>90%). Conclusion: The ARP reduces the amount of antibiotic usage, cuts down the healthcare expenditure, and may prevent a higher prevalence of some resistant bacterial strains; it is, therefore, in the interest of policymakers to propose an antimicrobial stewardship program based on mHealth system that allows patients, and healthcare providers an on-line and mobile consultation.