IMPLEMENTATION OF AN ANTIBIOTIC RESTRICTION FORMULARY AND THE IMPACT ON CONSUMPTION IN A ROMANIAN HOSPITAL: A THREE-YEAR RETROSPECTIVE STUDY

Antimicrobial resistance is a growing public health challenge exacerbated by excessive antibiotic use in hospitals.Antimicrobial stewardship programs (AMS) aim to optimise antibiotic prescribing to curb resistance.This study evaluates the impact of implementing a restriction formulary on antibiotic consumption in a Romanian hospital over three years.A retrospective analysis was conducted at Fundeni Clinical Institute in Bucharest from 2022 to 2024.Antibiotic consumption was quantified using the Defined Daily Dose (DDD) per 100 patient-days.The study compared antibiotic use before (2022) and after (2023 -2024) the implementation of a restriction formulary in December 2022.Statistical analyses assessed trends in antibiotic consumption across different hospital wards.Following the formulary's implementation, overall consumption of reserve antibiotics, including carbapenems and glycopeptides, declined, while narrower-spectrum agents, such as ceftazidime-avibactam and ertapenem, increased.The intensive care unit and haematology wards had the highest antibiotic usage.Although the formulary reduced the prescription of last-line antibiotics, total antibiotic consumption remained stable (p = 0.7).The restriction formulary effectively optimised antimicrobial selection, reducing the overuse of broad-spectrum antibiotics while promoting targeted therapies.However, continued monitoring is necessary to prevent resistance in newly preferred antibiotics and ensure long-term efficacy. RezumatRezistena la medicamentele antimicrobiene reprezint o provocare tot mai mare pentru sntatea public.Programele de stewardship antimicrobian (AMS) au ca obiectiv optimizarea prescrierii antibioticelor, n vederea limitrii apariiei rezistenei.Acest studiu a evaluat impactul implementrii unui formular de restricie asupra consumului de antibiotice ntr-un spital din Romnia, pe o perioad de trei ani.Analiza retrospectiv a fost realizat n cadrul Institutului Clinic Fundeni din Bucureti, n intervalul 2022-2024.Consumul de antibiotice a fost cuantificat utiliznd indicatorul Defined Daily Dose (DDD) raportat la 100 de zile de spitalizare.S-a analizat utilizarea antibioticelor nainte (2022) i dup (2023-2024) introducerea formularului de restricie, implementat n decembrie 2022.Astfel, a fost observat o scdere a consumului global de antibiotice de rezerv, precum carbapenemele i glicopeptidele, concomitent cu o cretere a utilizrii unor ageni cu spectru mai restrns, precum ceftazidim-avibactamul i ertapenemul.Seciile de terapie intensiv i hematologie au nregistrat cel mai ridicat consum de antibiotice.Dei formularul de restricie a redus prescrierea antibioticelor de rezerv, consumul total de antibiotice a rmas relativ constant (p = 0,7).Implementarea formularului de restricie s-a dovedit a fi o strategie eficient pentru optimizarea seleciei agenilor antimicrobieni, contribuind la reducerea utilizrii excesive a antibioticelor cu spectru larg i la promovarea terapiilor direcionate.Totui, este necesar monitorizarea continu pentru a preveni apariia rezistenei la antibioticele i pentru a menine eficacitatea tratamentelor pe termen lung.