Abstract
Objective:
This research study aimed to assess the impact of antimicrobial team review and intervention of discharge antibiotics.
Methods:
The study was a 6-month prospective observational trial in a 110-bed general governmental hospital conducted among adult inpatients (14 years and above) who were discharged on oral antibiotics on weekdays. The main outcome was the appropriateness of discharge antibiotics, whereas the secondary outcomes were the acceptance of recommendations and shortening the duration of antibiotics.
Results: s
A total of 153 cases were enrolled; the average age of the patients was 49.8 years, with a standard deviation of 19.5 years. The most common diagnoses were genitourinary tract infections, respiratory conditions, skin and soft tissue infection (SSTI), and surgical site infection (SSI). Amoxicillin/clavulanic acid (27.0%) and cefuroxime (25.0%) were the most common discharge antibiotics. The ASP team did not agree with the initial prescriptions in 65.4% cases, which was mainly because of excessive length or inappropriateness of indication. Antibiotic discontinuation (37.3%) and duration reduction (24.8%) were recommended. In 44.4% of cases, recommendations were accepted. A reduction in the mean planned antibiotic days to 6.40 ± 5.9 days during the time recommendations were accepted, compared to 8.7 ± 6.12 days. The exposure to antibiotics decreased by 1.98 days, which rose to 4.45 days in the accepted cases.
Conclusion:
ASP-based real-time monitoring of discharge antibiotics greatly enhanced the practice of prescribing and minimized unnecessary exposure to antibiotics. The extension of stewardship intervention at discharge is a good approach to streamline antimicrobial use and resistance.

Key words: Antibiotic stewardship, discharge antibiotics, antimicrobial stewardship, medication safety, Saudi Arabia