Inappropriate Antibiotic Prescribing in Different Departments of Gulf Region and Management Through Pharmacist-Led Antimicrobial Stewardship: A Systematic Review and Meta-Analysis

Abstract

Rana Kamran Mahmood22647, Syed Wasif Gillani22648*, Maryam Jaber Mohamed Abdulla Alzaabi22649 and Shabaz Mohiuddin Gulam22650

Purpose: The aim of this meta-analysis is to evaluate the inappropriate antibiotic prescribing in Gulf region and determine the effect of pharmacist-led antimicrobial stewardship programs to reduction in the inappropriateness.

Methods: Articles were searched, analyzed in quality assessed through JSM quality assessment tool to select the articles with low level of bias. In step 1 515 and in step 2 2357 articles searched and 32 articles included by critical analysis. Statistical analysis used to Risk ratio and standard mean differences were calculated using Review manager 5.4. 95% confidence intervals were calculated, using the fixed effect model. The I2 statistic assessed heterogeneity. In case of statistical heterogeneity, subgroup and sensitivity analyses then a random effect model was performed. The alpha threshold was 0.05. Primary outcome is inappropriateness in Gulf region and reduction of inappropriateness through AMS.

Results: Detailed review and analysis of 18 studies with inappropriateness in Gulf region shows risk of inappropriateness is 43669/100846 about 43.3%. Pooled RR=1.31 with 95% CI= (1.30, 1.32). Test with Overall effect is 58.87 in second step 28 antimicrobial stewardships led by pharmacist shows reduction in inappropriateness in AMS with pharmacist vs pre-AMS without pharmacist RR=0.36 with 95% CI= (0.32, 0.39).

Conclusion: Inappropriateness in Gulf region is alarming and need to be addressed through pharmacist-led antimicrobial stewardship programs.

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