Impact of Integrated Interventions of Prescriber Education and De-escalation Strategies on Implementing WHO Access: Insights from a South Indian Tertiary Care Setting

Abstract

Aims: This study evaluates the effect of integrated interventions including prescriber education and de-escalation strategies on improving antibiotic prescribing practices, optimizing the Access: Watch ratio, reducing Reserve antibiotic use, and improving Length of Therapy (LOT) adherence in a South Indian tertiary care hospital. Study Design: Prospective Observational Study. Place and Duration of Study: The study was carried out in Fortis Healthcare, Adyar for a period of five months (March to July 2023). Methodology: Data on Days of Therapy (DOT) and LOT were collected. Prescriber education and audit interventions were implemented, with pre- and post-intervention surveys to assess prescriber confidence in de-escalation. Results: The Access: Watch ratio improved from 0.45 to 0.52, with a marked reduction in Watch antibiotic consumption. DOT for Cefoperazone-Sulbactam, a Watch antibiotic, decreased from 50.7 to 18.1, and Reserve antibiotics (e.g., Linezolid and Colistin) showed significant reductions. LOT adherence to WHO guidelines improved for various infections, and prescriber confidence in de-escalation increased from 88.9% to 100%. Conclusion: Integrated interventions significantly optimized antibiotic use, achieved WHO Access: Watch targets, reduced Reserve antibiotic use, and enhanced prescriber practices. The study demonstrates the potential for similar strategies in other resource-limited settings to combat AMR.