ArticleJAC-antimicrobial resistance2021
Compliance with the 4Ds of antimicrobial stewardship practice in a tertiary care centre.
Article in JAC-antimicrobial resistance, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Assessing the impact of antimicrobial stewardship in low-income healthcare settings: a study of antibiotic use and antimicrobial susceptibility patterns in Indian hospitals.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- Correct sepsis classification-A must for antimicrobial stewardship: A longitudinal observational study.World journal of critical care medicine · 2025Article
- Antimicrobial prescription patterns in tertiary care centres in India: a multicentric point prevalence survey.EClinicalMedicine · 2025Article
- Impact of medical and pharmaceutical interventions on anti-infective prescriptions: an observational study.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2022Observational
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Authors and funding
3 authors.
Funding
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Abstract
backgroundAntimicrobial stewardship describes the practice of promoting the selection of the right drug, dosage, delivery and duration of antimicrobial therapy (the 4Ds) in order to curtail the emergence of resistant organisms. It is important to quantify the inappropriate use of antimicrobials in terms of percentage adherence to each of the 4Ds mentioned.
methodsWe undertook a prospective review of medical records of patients admitted to the medical wards of a tertiary care centre in North India. All patients on antimicrobials were included and their records reviewed for indication, drug, dose, delivery and duration (or by asking the treating physician if not documented). Adherence to the 4Ds was determined by referring to updated literature-based standard treatment guidelines (STGs) for each specific disease.
resultsOf 304 patients, drugs were appropriate and matched STGs in 218 (72%) patients, with adherence to the right dose in 210 (69%), route of delivery in 216 (71%) and duration in 197 (65%). Full adherence to the 4Ds was observed in 196 (64.5%). Maximum adherence was observed in treating skin and soft tissue infections (100%), while minimum adherence was observed in administering medical prophylaxis (40%). WHO Access, Watch and Reserve categories comprised 29%, 63% and 8.5% of all prescribed antibiotics, respectively.
conclusionsThe right drug, dose, delivery and duration of therapy are prescribed in 72%, 69%, 71%, and 65% of patients, respectively. In order to increase the adherence to 100%, bedside stewardship practices in the form of prospective audits and feedback must be improved. There is a need to integrate WHO AWaRe classification of antibiotics into treatment guidelines.
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