title: Antibiotic stewardship ward rounds and a dedicated prescription chart reduce antibiotic consumption and pharmacy costs without affecting inpatient mortality or re-admission rates.
abstract: BACKGROUND
  Antibiotic consumption is a major driver of bacterial resistance. To address the increasing burden of multi-drug resistant bacterial infections, antibiotic stewardship programmes are promoted worldwide to rationalize antibiotic prescribing and conserve remaining antibiotics. Few studies have been reported from developing countries and none from Africa that report on an intervention based approach with outcomes that include morbidity and mortality.
  
  
  METHODS
  An antibiotic prescription chart and weekly antibiotic stewardship ward round was introduced into two medical wards of an academic teaching hospital in South Africa between January-December 2012. Electronic pharmacy records were used to collect the volume and cost of antibiotics used, the patient database was analysed to determine inpatient mortality and 30-day re-admission rates, and laboratory records to determine use of infection-related tests. Outcomes were compared to a control period, January-December 2011.
  
  
  RESULTS
  During the intervention period, 475.8 defined daily doses were prescribed per 1000 inpatient days compared to 592.0 defined daily doses/1000 inpatient days during the control period. This represents a 19.6% decrease in volume with a cost reduction of 35% of the pharmacy's antibiotic budget. There was a concomitant increase in laboratory tests driven by requests for procalcitonin. There was no difference in inpatient mortality or 30-day readmission rate during the control and intervention periods.
  
  
  CONCLUSIONS
  Introduction of antibiotic stewardship ward rounds and a dedicated prescription chart in a developing country setting can achieve reduction in antibiotic consumption without harm to patients. Increased laboratory costs should be anticipated when introducing an antibiotic stewardship program.
authors.affiliation: Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
authors.forename: Tom H
authors.initials: TH
authors.lastname: Boyles
authors.affiliation: National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa ; Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa ; Division of Medical Microbiology, University of Stellenbosch, Cape Town, South Africa.
authors.forename: Andrew
authors.initials: A
authors.lastname: Whitelaw
authors.affiliation: National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa ; Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa.
authors.forename: Colleen
authors.initials: C
authors.lastname: Bamford
authors.affiliation: National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa ; Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa.
authors.forename: Mischka
authors.initials: M
authors.lastname: Moodley
authors.affiliation: National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa ; Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa.
authors.forename: Kim
authors.initials: K
authors.lastname: Bonorchis
authors.affiliation: Quality Assurance, Groote Schuur Hospital, Cape Town, South Africa.
authors.forename: Vida
authors.initials: V
authors.lastname: Morris
authors.affiliation: Pharmacy, Groote Schuur Hospital, Cape Town, South Africa.
authors.forename: Naazneen
authors.initials: N
authors.lastname: Rawoot
authors.affiliation: Pharmacy, Groote Schuur Hospital, Cape Town, South Africa.
authors.forename: Vanishree
authors.initials: V
authors.lastname: Naicker
authors.affiliation: Pharmacy, Groote Schuur Hospital, Cape Town, South Africa.
authors.forename: Irena
authors.initials: I
authors.lastname: Lusakiewicz
authors.affiliation: Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
authors.forename: John
authors.initials: J
authors.lastname: Black
authors.affiliation: Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
authors.forename: David
authors.initials: D
authors.lastname: Stead
authors.affiliation: Department of General Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Maia
authors.initials: M
authors.lastname: Lesosky
authors.affiliation: Division of General Internal Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
authors.forename: Peter
authors.initials: P
authors.lastname: Raubenheimer
authors.affiliation: Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
authors.forename: Sipho
authors.initials: S
authors.lastname: Dlamini
authors.affiliation: Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
authors.forename: Marc
authors.initials: M
authors.lastname: Mendelson
mesh_terms: D000900:Anti-Bacterial Agents; D004363:Drug Utilization / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data
chemical_list: D000900:Anti-Bacterial Agents