-lactamase
(ESBL)-producing gram-negative organisms (47% before and 25% after
restricting the cephalosporin use, P=0.03) [11].
Limiting antibiotic duration is another important
strategy to reduce antibiotic usage. The fixed antibiotic duration based
on sepsis category (probable sepsis vs. culture positive sepsis)
is questionable, and there has been constant attempt to reduce the
duration of antimicrobial therapy based on quantitative biomarkers.
Stocker, et al. [12] documented that procacitonin-guided
decision-making can reduce antibiotic duration in suspected early onset
sepsis. Caouto, et al. [13] showed CRP-guided approach shortens
length of antimicrobial treatment in culture proven late onset sepsis.
Saini, et al. [14] compared short course (48-96 hrs) of
antibiotics with standard seven day course for probable sepsis (septic
screen positive), and documented no difference in treatment failures.
In this issue of Indian Pediatrics, Jinka,
et al. [15], in their single center retrospective study, report
impact of antibiotic policy on antibiotic consumption in their NICU. The
overall antibiotic consumption was compared one year prior and one year
after introduction of antibiotic policy. There was no significant change
(12.47 vs. 11.47 DDD/100 patient-days; P=0.57) in overall
antibiotic consumption after introduction of antibiotic policy. They
documented that higher proportion of neonates received first-line
antimicrobials (66% vs. 84%; P<0.001), and consumption of
third generation cephalosporins was decreased (1.45 vs. 0.45
DDD/100 patient-days; P=0.002) after antibiotic policy. After
introduction of antibiotic policy, increase in the first line agents is
expected, but this did not translate into overall reduction in the
antibiotic usage in the current study. One reason could be because they
had chosen pharmacy-driven assessment tool i.e ATC/DDD, and
lacked the individual-level patient data. Another reason could be that
the sample size was not calculated to evaluate the differences from the
baseline data of their unit. However, the results are encouraging as the
proportion of neonates started on antibiotics decreased after initiation
of antibiotic policy.
Antibiotic stewardship is the need of the hour for
all NICUs, and to obtain best results the strategies should be modified
to the needs of NICU. Unit-specific antibiotic policy based on local
antibiogram and optimal duration of therapy in suspected or proven
sepsis is crucial to limit the unnecessary usage of broad-spectrum
antibiotics. Implementing the customized Quality Improvement (QI) tools
is the way forward to restrict unnecessary antibiotic use in Indian
health care settings. The last published National Neonatal Perinatal
Database for India was in 2002-03. There is compelling need to obtain,
analyze and disseminate the reliable data for India by using such a
quality collaborative, which can guide us to restrict overuse and to
avoid wide variability of use prevailing across different units.
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