Monday, 25 May 2015

Antibiotics: resistance and costs

The progressive power loss of antimicrobials against the most active microorganisms in infectious disease, especially in the hospital setting, makes systematic intervention absolutely necessary to optimize its prolonged use and its life, especially considering that there is sufficient evidence to think that with well-structured programs, we can reduce resistance and therefore solve very complicated clinical situations and in turn, lower the costs. A clear case of "Triple Aim", remember?: a) better quality, b) better outcomes, and c) lower costs.

What is ASP (PROA in Spanish)?

Two American scientific societies published in 2007 the guidelines for deploying Antimicrobial Stewardhip Programs (ASP) in health institutions. Five years later, in 2012, three Spanish scientific societies updated these guidelines in a consensus document that allows developing the Programs of Optimizing the use of Antimicrobials (PROA) in 7 parameters: 1) organizational aspects, 2) institutional support, 3) technical and humans resources, 4) objectives and indicators 5) educational interventions, 6) restrictive interventions and 7) non imposing  measures.

The Hospital Virgen del Rocío de Sevilla (Cisneros 2013) with a PROA focused on educational activities (parameter 5) reduced the inappropriate use of antibiotics by half in only one year and the corresponding costs by 42%. Four consulted studies documented that implementing PROA reduced spending on antimicrobials from 10% to 69% (Agwu 2008, Magendanz 2012, Malani 2013, Sick 2013). The scope of the cost reductions range is due to the fact that the starting points of the projects are different and so are the complexities of case-mix they worked with and the intensities of the respective programs, although all the cases confirm that PROA always returns the investment required almost immediately, sticking only to the pharmacy bill to which the savings due to clinical improvement of patients as a result of reduced resistances should be added.

In short, do not hesitate to implement an Antimicrobial Stewardship Program in your institution for the good of the sick and the budget, and don’t forget that those who know it say that the results are almost immediate. Well then, go on.


Cisneros JM, Neth O, Gil-Navarro MV, Lepe JA, Jiménez-Perrilla F, et al. Global impact of an educational antimicrobial stewardship programme on prescribing practice in a tertiary hospital centre. Clin Microbiol Infect. 2014 Jan;20(1):82-8. doi: 10.1111/1469-0691.12191. Epub 2013 Mar 20.

Agwu AL, Lee CK, Jain SK, Murray KL, Topolski J, Miller RE, Townsend T, Lehmann CU. A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center. Clin Infect Dis. 2008 Sep 15;47(6):747-53.

Magedanz L, Silliprandi EM, dos Santos RP. Impact of the pharmacist on a multidisciplinary team in an antimicrobial stewardship program: a quasi-experimental study. Int J Clin Pharm. 2012 Apr;34(2):290-4.

Malani AN, Richards PG, Kapila S, Otto MH, Czerwinski J, Singal B. Clinical and economic outcomes from a community hospital's antimicrobial stewardship program. Am J Infect Control. 2013 Feb;41(2):145-8.

Sick AC, Lehmann CU, Tamma PD, Lee CK, Agwu AL. Sustained savings from a longitudinal cost analysis of an internet-based preapproval antimicrobial stewardship program. Infect Control Hosp Epidemiol. 2013 Jun;34(6):573-80.

Jordi Varela


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