Shirazi Ovais Ullah, Ab Rahman Norny Syafinaz, Zin Che Suraya
Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia.
Big Data Research in Drug Utilization Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia.
J Pharm Bioallied Sci. 2020 Oct-Dec;12(4):369-380. doi: 10.4103/jpbs.JPBS_311_19. Epub 2020 Oct 8.
The overuse of antibiotics has led to various healthcare problems such as the emergence of resistance in infectious microbes and mortality due to antibiotic resistant healthcare associated infections (HAIs). An antimicrobial stewardship (AMS) program is the set of interventions used worldwide to enhance the rational use of antibiotics especially for the hospitalized patients. This review aimed to describe the characteristics of the implemented AMS programs in various hospitals of the world mainly focusing on the interventions and patients outcomes. The literature about AMS program was searched through various databases such as PubMed, Google Scholar, Science Direct, Cochran Library, Ovid (Medline), Web of Science and Scopus. In this review the literature pertaining to the AMS programs for hospitalized patients is sorted on the basis of various interventions that are categorized as formulary restriction (pre-authorization), guideline development, clinical pathway development, educative interventions and prospective audit. Moreover a clear emphasis is laid on the patient outcomes obtained as a result of these interventions namely the infection control, drop in readmission rate, mortality control, resistance control and the control of an overall cost of antibiotic treatment obtained mainly by curbing the overuse of antibiotics within the hospital wards. AMS program is an efficient strategy of pharmacovigilance to rationalize the antimicrobial practice for hospitalized patients as it prevents the misuse of antibiotics, which ultimately retards the health threatening effects of various antibiotics.
抗生素的过度使用已导致各种医疗保健问题，如传染性微生物耐药性的出现以及因耐抗生素的医疗保健相关感染（HAIs）导致的死亡。抗菌药物管理（AMS）计划是全球范围内用于促进抗生素合理使用的一系列干预措施，特别是针对住院患者。本综述旨在描述世界各地不同医院实施的AMS计划的特点，主要关注干预措施和患者结局。通过各种数据库搜索有关AMS计划的文献，如PubMed、谷歌学术、科学Direct、Cochrane图书馆、Ovid（Medline）、科学网和Scopus。在本综述中，与住院患者AMS计划相关的文献根据各种干预措施进行分类，这些干预措施分为处方限制（预先授权）、指南制定、临床路径开发、教育干预和前瞻性审核。此外，还明确强调了这些干预措施所取得的患者结局，即感染控制、再入院率下降、死亡率控制、耐药性控制以及主要通过遏制医院病房内抗生素的过度使用而实现的抗生素治疗总体成本控制。AMS计划是一种有效的药物警戒策略，可使住院患者的抗菌药物使用合理化，因为它可防止抗生素的滥用，最终减缓各种抗生素对健康的威胁作用。
