Infectious diseases in neonates caused by viruses, fungi or bacteria are reported to cause around 550,000 deaths each year. Antibiotics are one of the most frequently prescribed medications in the NICU, with the most common route being intravenous administration.
One way to control the wise use of antibiotics in Indonesia is to group antibiotics into AWaRe categories, namely Access, Watch and Reserve. This categorization supports WHO plans to control antimicrobial resistance. The government has stipulated through Regulation of the Minister of Health of the Republic of Indonesia Number 28/2021 to monitor and regulate the wise use of antibiotics in health facilities. Since 2011, WHO has established an anatomical therapeutic chemical (ATC) classification system and measurements using DDD as a standard for measuring the quantity of antibiotic use. Meanwhile, for quality evaluation, the Gyssens flow diagram assessment is used. This evaluation aims to provide information regarding patterns of antibiotic use in health facilities, both in terms of quantity and quality. So it is hoped that the quantity and quality of AWARE antibiotic use can be evaluated. Antibiotic treatment in the NICU varies widely, leading to inappropriate overuse. This study aims to evaluate the use of antibiotics quantitatively and qualitatively in neonatal patients in the NICU at Airlangga University Hospital, Surabaya. Quantitative analysis was carried out using the ATC/DDD method, while qualitative analysis was carried out using the Gyssens method.
This study used an observational method with a descriptive analysis design without any intervention applied to the patients. Data collection was carried out retrospectively by reviewing the medical records of neonatal patients treated in the NICU at Airlangga University Hospital from 1 January 2021 to 31 December 2022. A total sampling technique was used, which included all patients who met the specified inclusion and exclusion criteria. Inclusion criteria were neonatal patients aged ≤ 28 days who received antibiotic treatment, and no exclusion criteria were set. This research has obtained ethical approval no. 075/KEP/2023, and data on antibiotic use in NICU patients were analyzed quantitatively using the DDD/100 patient days method and qualitatively using the Gyssens method (Fig. 1) recommended by WHO. DDD calculations in hospitals use the formula:
This study analyzed the use of antibiotics quantitatively and qualitatively in neonatal patients, by obtaining a sample of 63 patients. Based on research results, ampicillin is the most widely used antibiotic, namely 32%.
Sepsis was the most common type of disease, affecting 43 patients (45%), followed by RDS in 26 patients (27%), and asphyxia in 18 patients (19%). The type of disease was correlated with the antibiotics used in the Gyssens analysis.
The evaluation of antibiotic use consisted of a quantitative analysis using the ATC/DDD method and a qualitative study using the Gyssens criteria to assess rationality. Gyssens analysis showed that rational antibiotic use (category 0) was achieved in 110 antibiotic uses (91%). There were 2 cases (2%) characterized by more effective antibiotics (category IV A), 2 cases (2%) where more specific antibiotics with a narrower spectrum were available (category IV A), 4 cases (3%) with inappropriate dosing (category IIA), and 2 cases (2%) where the antibiotic interval was inappropriate (category IIB). In addition, the research results showed that ampicillin-sulbactam had the highest DDD value. Apart from quantitative analysis, a qualitative study was also carried out using the Gyssens method, with 91% of antibiotic use falling into category 0.
Clinical results after treatment in the NICU and administration of antibiotics showed that 62 patients (98%) were discharged alive, either recovered or able to continue outpatient treatment, while 1 patient (2%) was recorded as having died.
In conclusion, quantitative analysis using the DDD method per 100 patient days showed that the top three most widely used antibiotics were ampicillin-sulbactam, ampicillin (classified as access), and meropenem (classified as reserve). Meanwhile, a qualitative study using the Gyssens method showed that antibiotic use was categorized as rational in 91% of cases, with inappropriate doses (category II A) observed in 3%, inappropriate intervals (category II B) in 2%, alternative antibiotics which is more effective (category IV A) in 2%, and incomplete medical record data (category VI) in 2% of cases. These findings underscore the importance of collaboration between neonatologists as prescribers and clinical pharmacists in monitoring, evaluating and managing antibiotic use so as to increase the wise and rational use of antibiotics in neonatal patients.
Author: Dr. apt. Yulistiani, M.Sc
Also read: Necrotizing Enterocolitis in Neonates with Mothers Positive for Covid-19
The Antibiotic Tango in the Neonatal ICU
Infectious Diseases: The Silent Killers of Neonates
Ah, the NICU—where the tiniest humans are treated with the biggest of medications. And let’s face it, folks: with around 550,000 infant deaths each year caused by infectious diseases, it’s time to put on our thinking caps (and maybe a lab coat or two).
Neonates are delicately balanced creatures; they’re not miniature adults. They’re, like, the houseplants of the medical world—water them improperly, and it is *cue dramatic music* game over. Enter antibiotics, the saving grace and often the go-to prescription in the NICU. The irony? The most common way to deliver these lifesavers is through an IV—don’t worry, they’re not getting a caffeine drip. Yet, the urgent need for a more judicious use of these drugs looms large!
AWaRe: The Antibiotic Matrix
So, how do we battle this increasing menace of antimicrobial resistance? The Indonesian government has a plan—classifying antibiotics! Yes, sorting like a teenage girl going through her closet: *Access, Watch, Reserve*. The AWaRe categories, suggested by the WHO, aim to curb antibiotic misuse before it spirals out of control faster than you can say “superbug.”
On the surface, this sounds like great news! A sprinkle of organization in a world where antibiotics were wielded like confetti at a parade. And let’s not forget—the WHO has laid down the law with a whole lot of acronyms and strategies to study antibiotic use. Who knew reading about antibiotic utilization could feel this much like a thriller novel?
The Study: A Deep Dive into Antibiotic Practices
Now, Dr. Yulistiani and her team at Airlangga University Hospital took the plunge into the fascinating yet murky waters of antibiotic use. They decided to peel back the layers on 63 neonates (yes, no need for fancy focus groups here) receiving antibiotics from January 2021 to December 2022. And let me tell you, the findings are nothing short of… well, educational.
Sepsis, with its formidable reputation, graced the stage by affecting 43 patients (that’s 45%)! Meanwhile, RDS and asphyxia were also well-represented, making this the quietest party in history. But let’s get to the real meat of the matter: how was this antibiotic cocktail being served?
Numbers Don’t Lie… Mostly
Quantitative analysis reveals that ampicillin is drinking the champagne of approval, taking the lead in antibiotic prescriptions at 32%. Like the popular kid in school, it dominates the scene while we’ve got a sprinkle of meropenem—also popular, but in the reserve category—hanging out at a safe distance.
Rational use? Well, according to the Gyssens method (which sounds more like a rare foreign film than a tool for evaluating oncology), 91% of antibiotic use was categorized as rational! That’s a huge win! But hold your applause, because we’re not quite out of the woods yet. There were a few cases of inappropriate dosing and intervals that might make you clutch your pearls!
Cranking Up the Collaboration
With 98% of patients feeling better and strutting out of that NICU operation like they just won a gold medal at the Olympics, it’s clear that collaboration is key! Neonatologists need to work hand in hand with clinical pharmacists. This isn’t about playing who-can-prescribe-faster; this is about crafting a well-oiled antibiotic machine that’ll make even a Swiss watch jealous.
The Takeaway
In conclusion, this study is a reminder that while antibiotics are life-saving, they should be treated with the respect they deserve—more like treasured family heirlooms and less like yesterday’s leftovers. It’s vital to ensure that the quantity and quality of antibiotic use in neonates are not just a fleeting goal but a regular practice!
Coming Soon: The New Danger – Necrotizing Enterocolitis in Neonates!
Also, keep an eye on our next article where we dive into the terrifying world of necrotizing enterocolitis in neonates with mothers who tested positive for Covid-19. Who knew parenting could involve so much jargon? Stay tuned!
How does the AWaRe framework influence antibiotic prescribing practices in neonatal healthcare settings?
**Interview with Dr. Yulistiani: The Antibiotic Tango in the Neonatal ICU**
**Interviewer:** Welcome, Dr. Yulistiani! Your recent study on antibiotic use in neonates at Airlangga University Hospital is both fascinating and alarming. Can you start by sharing what kind of impact infectious diseases have on neonates?
**Dr. Yulistiani:** Thank you for having me! Infectious diseases are indeed a significant concern in neonates, responsible for around 550,000 deaths each year. These tiny patients are extremely vulnerable, and the NICU environment needs to be particularly vigilant to ensure their safety and health.
**Interviewer:** Your study involved a detailed examination of antibiotic utilization in neonates over a two-year period. What were the most striking findings regarding antibiotic prescriptions?
**Dr. Yulistiani:** Our analysis showed that sepsis was the leading condition, affecting 45% of the patients we studied. We found that ampicillin emerged as the most commonly prescribed antibiotic at 32%. While it’s essential for treating infections, we need to ensure its use is appropriate to avoid contributing to antimicrobial resistance.
**Interviewer:** Speaking of resistance, you mentioned the AWaRe categories developed by the WHO. How do these classifications help in managing antibiotic use?
**Dr. Yulistiani:** The AWaRe framework—Access, Watch, Reserve—provides a structured approach to antibiotic prescription. By categorizing antibiotics based on their importance and potential for resistance, it promotes rational use. This is especially crucial in a setting like Indonesia, where misuse has been a growing issue.
**Interviewer:** I found it intriguing that 91% of the antibiotic use in your study fell into the ‘rational’ category per the Gyssens analysis. What does this mean for clinical practice?
**Dr. Yulistiani:** It’s a promising indication that the majority of prescriptions are justified. However, we did notice a few instances of inappropriate dosing and intervals. This highlights the need for ongoing collaboration between neonatologists and clinical pharmacists to refine our antibiotic stewardship practices continually.
**Interviewer:** Your study has revealed some significant insights into the use of antibiotics in the NICU. What do you believe will be the most critical steps moving forward?
**Dr. Yulistiani:** Moving forward, it’s crucial to enhance our monitoring systems and foster communication among healthcare teams. Regular audits and training can help reinforce appropriate prescribing practices. We aim to ensure that our neonates receive the safest and most effective care while also safeguarding against the risk of developing antibiotic resistance.
**Interviewer:** Thank you, Dr. Yulistiani, for sharing your insights. Your work is vital in the pursuit of safer and more effective treatments for neonates in the NICU.
**Dr. Yulistiani:** Thank you for the opportunity to discuss this important topic! It’s all about collaboration and commitment to improving healthcare outcomes for our most vulnerable patients.
