A study published online in Lancet Infectious Diseases, 13 June 2016, looked at the implementation and outcomes of an antimicrobial stewardship programme across 47 rural and urban private hospitals in South Africa.

To date, implementation of antibiotic stewardship programmes in South Africa have been limited by the paucity of infectious diseases specialists and resources. The current study investigated using existing resources. The study was divided into three phases, namely pre-implementation, implementation and post-implementation. During the pre-implementation phase doctors, pharmacists and nursing staff were trained about the five proposed interventions after which the interventions were implemented. Ongoing learning processes were conducted from time to time as the processes were implemented.

Five process measures were chosen, and pharmacists then recommended interventions as required, after consultation with the prescribing doctor. The five process measures were: cultures not done before starting empiric antibiotics, antibiotic treatment for more than 7 days, antibiotic treatment for more than 14 days, more than four antibiotics concurrently and overlapping or duplicate spectra of activity.

The effect on antibiotic consumption was assessed using the WHO index of defined daily doses per 100 patient-days.

Almost one in 15 prescriptions required an intervention and there was a sustained reduction in antibiotic consumption in the group as a whole of 18.1%, showing that non-infectious disease specialists can successfully engage in antibiotic stewardship programmes, which shows promise for resource-constrained settings.