Results of implementation of a pilot antimicrobial stewardship program (ASP) in Primary Care

Background. The aim of this study was to evaluate the implementation of a pilot antimicrobial stewardship program (ASP) in Primary Health Care teams (PHCT) in Navarre (Spain). Material and methods. Non-randomized experimental study performed with data obtained from the electronic pharmacy records. Differences in consumption of antibiotics before (2018) and after (2019) ASP implementation in twelve PHCT were calculated. Another twelve PHCT without ASP were used for comparison. We analysed data on global and beta-lactams, fluoroquinolones, macrolides, cephalosporines and fosfomycin-trometamol, expressed in number of treated patients and DDD (defined daily doses). Results. The number of patients with prescribed antibiotics decreased significantly more in PHCT with ASP (-9.1 vs. -1.7%), particularly with fluoroquinolones (-25 vs. -20.4%), macrolids (-20.4 vs. -8.5%) and amoxicillin-clavulanic (-10.3 vs. -2.5%). Decreased DDD followed the same pattern. Both PHCT groups kept constant the number of patients with prescribed third generation cephalosporins, while those with prescribed first generation cephalosporins and betalactamase-sensible penicilins increased similarly. In PHCT with ASP, increased number of patients with prescribed phosphomycin-trometamol was smaller (4.0 vs. 11.5%) while its consumption expressed in DDDs was reduced while increasing in PHCT without ASP (-1 vs. 10%, p<0.001). Conclusions. PHCT with ASP resulted in a significantly greater decrease in the global use of antimicrobials, fluoroquinolones, macrolides and amoxicillin-clavulanic than PHCT without ASP. These very positive results promoted their extension to the remaining PHCT.