Division of Infectious Diseases, Department of General Medicine, Amrita Institute of Medical Science and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
Department of Respiratory Medicine, Amrita Institute of Medical Science and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
PLoS One. 2024 Nov 5;19(11):e0310493. doi: 10.1371/journal.pone.0310493. eCollection 2024.
Tuberculosis (TB) remains a significant public health challenge in Low- and Middle-Income Countries (LMIC). Inappropriate use of Anti-Tubercular Treatment (ATT) undermines treatment efficacy and could contribute to drug resistance. While antimicrobial stewardship programs (AMSP) are well established, anti-tubercular treatment stewardship programs (ATTSP) in private hospitals do not have an established model. An AMSP model in a private tertiary care hospital in South India was repurposed to monitor the prescription appropriateness of ATT. A multidisciplinary team evaluated the ATT prescription appropriateness among inpatients over a one-year period with the 4R's criteria: Right Indication, Right Drug, Right Dose, and Right Frequency. The ATTSP team filed recommendations for inappropriate prescriptions to the primary clinical care team, and compliance to the recommendations was documented within 48 hours. During the study period, 172 ATT prescriptions were evaluated. Inappropriate dose and drug prescriptions were found in 16% and 7%, respectively. The primary clinical care teams complied with 83% of the recommendations within 48 hours. The potential impact of implementing the ATTSP model nationwide was assessed using published data, suggesting that the opportunities to correct inappropriate prescriptions could reach a quarter million. The study provides a proof of concept that an ATTSP can be successfully implemented in a TB endemic, resource-constrained setting. Extrapolation for implementing ATTSP across the country has the potential for huge public health benefits.
结核病（TB）仍然是中低收入国家（LMIC）面临的重大公共卫生挑战。抗结核治疗（ATT）使用不当会降低治疗效果，并可能导致耐药性。虽然抗菌药物管理计划（AMSP）已经建立，但私立医院的抗结核治疗管理计划（ATTSP）没有既定的模式。印度南部一家私立三级保健医院的 AMSP 模式被重新用于监测 ATT 的处方适宜性。一个多学科团队在一年的时间里，根据 4R 标准评估了住院患者的 ATT 处方适宜性：正确的适应症、正确的药物、正确的剂量和正确的频率。ATTSP 团队向初级临床护理团队提出了不适当处方的建议，并在 48 小时内记录了对建议的遵守情况。在研究期间，评估了 172 份 ATT 处方。发现剂量和药物不适当的处方分别占 16%和 7%。初级临床护理团队在 48 小时内遵守了 83%的建议。使用已发表的数据评估了在全国范围内实施 ATTSP 模型的潜在影响，表明纠正不适当处方的机会可能达到 25 万。该研究提供了一个概念验证，即在结核病流行、资源有限的环境中可以成功实施 ATTSP。在全国范围内实施 ATTSP 有可能带来巨大的公共卫生效益。
