Implementing antibiotic clinical guidelines in a local Iranian hospital: a mixed-methods evaluation

Antibiotic guidelines facilitate rational prescribing practices, enhance patient health outcomes, mitigate the development of microbial resistance, and contribute to cost containment. An instruction was issued in Iran in 2019 mandating the prescription of eight high-cost antibiotics in hospital settings. This research aims to assess the impact of the instruction on antibiotic utilization and associated hospital costs. As the respected reviewer mentioned, the abstract section is majorly revised in method and the requested informations are added as “This study is a mixed method which used both quantitative and qualitative phases. The quantitative phase run as follows: patient records data from Kerman University of Medical Sciences hospitals were reviewed and gathered for those receiving at least one of eight target antibiotics. Data on vial count and length of stay were extracted pre- and post-guideline using HIS. Analyses used Shapiro–Wilk and Wilcoxon tests (Stata v14). Costs were calculated based on average hospital-provided vial prices. The qualitative phase aimed to identifying challenges and searching alternatives for precise implementation of guidelines and the data gathered used the expert panel method while data analyzed using MAXQDA ver20. There was a significant rise in the total use of costly antibiotics per patient in the year following the guideline (P ≤ 0.0176), but this decreased in the second year. However, this reduction was not statistically significant (P ≤ 0.8124). The expert panel findings related to the qualitative phase, showed the main challenges of the guidelines implementation and probable solutions while revealed the importance of providing feedback to service providers while educating them on how these can help with health system costs and patient’s outcome. The guidelines implementation led to a decrease in the total prescription of antibiotics but it also revealed an increase in specific patient groups who needed antibiotics in a more specific way which could indicate that in the first years of guidelines implementation, due to the focus on implementation and providing feedbacks, prescribing became more precise, and instead of prescribing more antibiotics to all patients, some of whom may not have needed these drugs, prescriptions have increased significantly for specific patients requiring treatment with these antibiotics. Although the guideline implementation could resulted in health system’s costs and more precise prescriptions but there found challenges in implementations which need participation from all policy performers and process coordinators while focusing the education, monitoring and corrective feedbacks.