1. Antimicrobial Stewardship Program in Saudi Arabia;
Pharma Middle East 2015
Dubai, UAE
Antimicrobial Stewardship Program in Saudi Arabia;
Experiences and Vision Future 
Yousef A. Alomi, Bsc., Msc, BCPS, BCNSP, DiBA
General Manager of General Administration of Pharmaceutical Care
November 2015

2. Disclosure Yousef A. Alomi Reports No Relevant Financial Relationship
Pharma Middle East 2015
Dubai, UAE
Disclosure
Yousef A. Alomi
Reports No Relevant Financial Relationship

3. Learning Objectives Pharma Middle East 2015 Dubai, UAE
Understand Antimicrobial Stewardship Program at MOH Saudi Arabia
Know the Assessment Plan of Antimicrobial Stewardship Program
How to Implement Antimicrobial Stewardship Program to all Middle East countries

4. Antimicrobial Stewardship Program
“an ongoing effort
by a health care institution to optimize antimicrobial use among hospitalized patients
in order to improve patient outcomes, ensure cost-effective therapy, and reduce adverse
sequelae of antimicrobial use (including antimicrobial resistance)
Allerberger, F. and H. Mittermayer (2008). “Antimicrobial stewardship.”
Clinical Microbiology and Infection 14(3):

6. Three levels of demand were used sequentially until an antibiotic was dispensed or denied [4]: 1) Can I have something to relieve my symptoms?: 2) Can I have something stronger? 3) I would like to have antibiotic.

7. Saudi Pharmaceutical Journal (2014) 22, 550–554

8. Saudi Pharmaceutical Journal (2014) 22, 550–554

9. Saudi Pharmaceutical Journal (2014) 22, 550–554

12. Alumran et al. Health and Quality of Life Outcomes 2013, 11:39

14. The antimicrobial stewardship program in Gulf Cooperation Council (GCC) states: insights from a regional survey Journal of Infection Prevention October 8, 2015
Objectives: The purpose of the current study is to describe the prevalence and characteristics of antimicrobial stewardship programs (ASP) in Gulf Cooperation Council (GCC) states to explore opportunities and overcome barriers to effective ASP implementation.
Methods: A cross-sectional questionnaire survey was used to evaluate the current status of ASP: major stewardship components, barriers of implementation and program impact in acute care hospitals of GCC states.
Results: Forty-seven healthcare professionals responded from four GCC states, the majority from Saudi Arabia (81%). Twenty-nine (62%) participating hospitals had ASP in place. Of these established programs, 35 (75%) reported lack of funding and personnel as major barriers to program implementation. The top three objectives cited for the hospital ASP were to reduce resistance (72.3%), improve clinical outcomes (70.2%) and reduce costs (44.7%). The reported impact of existing ASP was reduction of inappropriate prescribing (68%), reduction of broad spectrum antibiotic use (63.8%), reduction of healthcare-associated infections (61.7%), reduction of length of stay or mortality metrics (59.6%), reduction in direct antibiotic cost (57.4%) and reduction of reported antibiotic resistance (55.3%).
Conclusion: Survey participants from GCC states who have implemented ASP report significant impacts in the reduction of broad spectrum antibiotic use, hospital-acquired infection, inappropriate prescribing and antimicrobial resistance. These findings suggest a promising opportunity to enhance existing ASP through sharing of best practices and support the development of regional guidelines across GCC states.

15. Antimicrobial stewardship program implementation in a medical intensive care unit at a tertiary care hospital in Saudi Arabia. Amer MR, Akhras NS, Mahmood WA, Al-Jazairi AS1.
BACKGROUND AND OBJECTIVES:
Antimicrobial stewardship programs (ASPs) have shown to prevent the emergence of antimicrobial resistance associated with an inappropriate antimicrobial use. The primary objective of this study was to compare the prescribing appropriateness rate of the empirical antibiotic therapy before and after the ASP implementation in a tertiary care hospital. Secondary objectives include the rate of Clostridium difficile-associated diarrhea (CDAD), physicians' acceptance rate, patient's intensive care unit (ICU) course, total utilization using defined daily dose, and total direct cost of antibiotics.
DESIGN AND SETTINGS:
This is a comparative, historically controlled study. Adult medical ICU patients were enrolled in a prospective fashion under the active ASP arm and compared with historical patients who were admitted to the same unit before the ASP implementation. This study was approved by the institutional review board, and the need for informed consent was waived because the interventions and recommendations were evidence based and considered the standard of care. The study was conducted at KFSHRC, Riyadh.
Ann Saudi Med Nov-Dec;33(6):

16. Antimicrobial stewardship program implementation in a medical intensive care unit at a tertiary care hospital in Saudi Arabia. Amer MR, Akhras NS, Mahmood WA, Al-Jazairi AS1.
METHODS:
Adult medical ICU patients were enrolled under the active ASP arm if they were on any of the 5 targeted antibiotics (piperacillin/tazobactam, imipenem/cilastatin, meropenem, vancomycin, tigecycline), and had no official infectious disease consultation. The interventions were conducted via prospective audit and feedback.
RESULTS:
A total of 73 subjects were recruited, 49 in historical control and 24 in the active arm. The appropriateness of empirical antibiotics was improved from 30.6% (15/49) in the historical control arm to 100% (24/24) in the proactive ASP arm (P value < .05). For the ASP group, initially 79.1% (19/24) of the antibiotic uses were inappropriate and diminished by ASPs to 0% on the recommendations implementation. A total of 27 interventions were made with an acceptance rate of 96.3%. The rate of CDAD did not differ between the groups. A reduction in antibiotics utilization and direct cost were also noticed in the ASP arm.
CONCLUSION:
A proactive ASP is a vital approach in optimizing the appropriate empirical antibiotics utilization in an ICU setting in tertiary care hospitals. This study highlights the importance of such a program and may serve as a foundation for further ASP initiatives particularly in our region.
Ann Saudi Med Nov-Dec;33(6):

26. Skeleton of Committees
Pharma Middle East 2015
Dubai, UAE
Skeleton of Committees
Central antibiotics committee
Regional antibiotic committee
Hospital Antibiotic committee
Primary Care Centres Antibiotic committee

27. Antimicrobial Stewardship Program Plan
Pharma Middle East 2015
Dubai, UAE
Antimicrobial Stewardship Program Plan
2014
 Stage 1
 Antibiotic Committee Central 
 Antibiotic Committee Region 20
 Antibiotic Committee Peripheral 90 Hospital 
 Antibiotic adults Manual booklet and electronic 
 Antibiotic Training Courses Central 
 Antibiotic training courses region 20 

28. Antimicrobial Stewardship Program Plan
2015
Stage 2 
 Antibiotic Committee Peripheral additional 90 Hospital 
 Antibiogram Central 
 Antibiogram 20 Region
 Antibiogram 90 Hospital 
 Antibiotic pediatrics Manual booklet and electronic 
 Review Antibiotic Adults Manual base on antibiogram 
 Antibiotic utilization 
 Antibiotic consumption 
 Antibiotic Training Courses Central 
 Antibiotic training courses region 20
Stewardship Antibiotics Residency Program (ASHP) 

29. Antimicrobial Stewardship Program Plan
2016
Stage 3 
 Antibiotic Committee Peripheral additional 60 Hospital 
 Antibiogram Central 
 Antibiogram 20 Region
 Antibiogram 180 Hospital 
 Antibiotic pediatrics Manual booklet and electronic 
 Review Antibiotic Adults Manual base on antibiogram 
 Antibiotic utilization adults and pediatrics 
 Antibiotic consumption adults and pediatrics 
 Antibiotic Training Courses Central 
 Antibiotic training courses region 20
Follow Up Stewardship Antibiotics Residency Program (ASHP)  

30. Antimicrobial Stewardship Program Plan
2017
Stage 4 
 Antibiotic Committee 90 Private Hospital 
 Antibiogram Central 
 Antibiogram 20 Region adults and pediatrics 
 Antibiogram 250 Hospital adults and pediatrics 
 Review Antibiotic pediatrics Manual booklet and electronic 
 Review Antibiotic Adults Manual base on antibiogram 
 Antibiotic utilization adults and pediatrics
 Antibiotic consumption adults and pediatrics 
 Antibiotic Training Courses Central 
 Antibiotic training courses region 20 
 Follow Up Stewardship Antibiotics Residency Program (ASHP)

31. Antimicrobial Stewardship Program Plan
2018
Stage 5
 Antibiotic Committee additional 90 Private Hospital
 Antibiogram Central 
 Antibiogram 20 Region adults and pediatrics 
 Antibiogram 250 Hospital adults and pediatrics 
 Antibiogram in 90 Private Hospital 
 Review Antibiotic pediatrics Manual booklet and electronic 
 Review Antibiotic Adults Manual base on antibiogram 
 Antibiotic utilization adults and pediatrics in MOH and Private 
 Antibiotic consumption adults and pediatrics in MOH and Private
 Antibiotic Training Courses Central in MOH and Private
 Antibiotic training courses region 20 in MOH and Private
Follow Up Stewardship Antibiotics Residency Program (ASHP)  

33. Guideline for Establish Antimicrobial Stewardship at MOH hospitals
Section I: Policy and procedure
Section II: National antimicrobial guideline: Group A streptococcal Pharyngitis Acute Bacterial Rhinosinusitis Community Acquired Pneumonia Bacterial Meningitis Brain Abscess Infective endocarditis Urinary Tract Infection Osteomyelitis Diabetic Foot Infection Skin and Soft Tissue Infection Peritonitis Sexually Transmitted Disease Pelvic Inflammatory Disease Intra-abdominal Infection Brucellosis Tuberculosis Antiviral Infection Antifungal Infection Parasitic Infection Surgical Prophylaxis
Appendix A: Guideline for blood culture collection
Appendix B: Infection Control
Appendix C: Skin test kits, Anaphylactic kits , Skin test procedure and anaphylaxis algorithm
Appendix D: Antibiotics dosing monitoring
Appendix E: Practical Approaches for Conversion IV antibiotics to Oral therapy Appendix F: Antibiogram
Appendix G: Antimicrobial Consumption
Appendix H: Formulary/ Pre-Authorization Restricted Forms
Appendix I: Abbreviation
Appendix J: Dose Adjustment for Renal Impairment

35. Guideline for Establish Antimicrobial Stewardship
at MOH hospitals
The antimicrobial stewardship team and administrative support
Core members of antimicrobial stewardship:
Infectious diseases physician ( Leader )
Clinical pharmacist with infectious diseases training (Coordinator)
Clinical microbiologist
An information system specialist
An infection control professional
hospital epidemiologist
Administrative support:
Hospital administration (necessary infrastructure)
Medical staff leadership
local providers ( e.g: nurses)
Collaborated providers:
Hospital infection control
Pharmacy and therapeutics committees

36. Guideline for Establish Antimicrobial Stewardship
at MOH hospitals
Core strategies:
Prospective audit with intervention and feedback
Formulary restriction and preauthorization:
Supplemental Antimicrobial Stewardship Strategies:
Education
Guidelines and clinical pathways
Antimicrobial order forms
Combination empirical therapy and de-escalation antimicrobial
Conversion from parenteral to oral therapy
Antimicrobial dosing
Surveillance of antimicrobial resistance
Computer Surveillance and Decision Support
Monitoring of Process and Outcome Measurements

39. Policy This guideline only for adult
Pharma Middle East 2015
Dubai, UAE
Policy
This guideline only for adult
Antibiotics order form is controlled and guided method to all health provider(physician, pharmacist, clinical pharmacist and nurse during prescribing the antibiotics
It is formatting as physician order
Using of this order form only for community acquired infection.

40. Antimicrobial Stewardship
Antibiotic Committees
Infectious Diseases Team
Antibiotics Physician order Form
Antibiotics dosing monitoring Aminogylcoside, Vancomycin
Switching IV antimicrobial to oral
Dose adjustment for Renal Impairment
Antibiotics Consumption
Antibiogram

43. Monthly antibiotics consumption

51. Antimicrobial Stewardship Program Indicators
2014
2013
2012 No 1
Antibiotics Committee
(Central) 15 20
(Region)
250
(Peripheral)
80-100
(PCC)
Antibiotics Manual
Booklet
Antibiotics Manual Electronic
Antibiogram (Central)
Antibiogram (Region)
Antibiogram (Peripheral)

52. Antimicrobial Stewardship Program Indicators
2014
2013
2012 No 1
Antibiotics Consumption
(Central) 20
(Region)
250
(Peripheral)
80-100
(PCC)
Antibiotics Utilization Review
Antibiotic Conference

53. Antimicrobial Stewardship Program Indicators
2014
2013
2012 No 1 2
Antibiotics Course
(Central)
2-4
(Region)
250
(Peripheral)
80-100
(PCC)
Therapeutic Drug Monitoring 20

54. Antimicrobial Stewardship Program Indicators
2014
2013
2012 No 1
Decrease 20%
Resistance Bugs
(Central)
(Region)
(Peripheral)
Will not increase
Infection Rate

55. Stewardship Antibiotics Program Indicators
2014
2013
2012 No 1
Decrease 20-50%
Antibiotics Cost Reduction
(Central)
(Region)
(Peripheral)
(PCC)
50%
Privilege of Antibiotics Prescribing

56. Stewardship Antibiotics Program Indicators
2014
2013
2012 No 1
50%
Antibiotics Policy Adherence
(Central)
(Region)
(Peripheral)
(PCC)
Antibiotics Automatic Stop order

57. Antimicrobial Stewardship Program Indicators
2014
2013
2012 No 1
Days of Therapy (DOT)
(Central)
(Region)
(Peripheral)
(PCC)
Defined Daily Dose (DDD)

58. Antimicrobial Stewardship Program Indicators
2014
2013
2012 No 1
Post Marketing Surveillance
(Central)
(Region)
(Peripheral)
(PCC)
Drug Quality Reporting System

59. Antimicrobial Stewardship Program Indicators
2014
2013
2012 No 1
Antibiotic Medication Errors
(Central)
(Region)
(Peripheral)
(PCC)
Antibiotic Adverse Drug Reaction

60. Antimicrobial Stewardship Program Indicators
2014
2013
2012 No 1
No of Mortality due to Infections
(Central)
(Region)
(Peripheral)
No of Parenteral Antibiotic
(PCC)

62. Pharma Middle East 2015
Dubai, UAE
Conclusion