Antibiotic usage at a private hospital in Central Java: results of implementing the Indonesian Regulation on the Prospective Antimicrobial System (Regulasi Antimikroba Sistem Prospektif Indonesia [RASPRO])

Methods: A pre–post-descriptive study was conducted in 2019 for 3 months at a private hospital in Central Java, Indonesia, to evaluate the implementation of the Regulation on Indonesian Antimicrobial Stewardship Program (ASP), namely, the Prospective Antimicrobial System/Regulasi Antimikroba Sistem Prospektif Indonesia (RASPRO). Outcomes were measured before and after the implementation of the RASPRO in the ward including: 1) intravenous antibiotic defined daily dose (DDD) per 100 patient-days, 2) antibiotic expenditure, and 3) antibiotic expenditure per inpatient. Result: The total antibiotic consumption was expressed in DDD/100 patient-days. For the levofloxacin category, the number increased intensely from 2.38 to 15.29; carbapenem escalated from 0.51 to 2.31, ceftriaxone from 32.10 to 38.03, and ampicillin sulbactam from 1.14 to 1.18. In contrast, cefuroxime significantly reduced from 17.25 to 1.38, cefotaxime decreased from 10.33 to 6.83, gentamicin decreased from 3.18 to 1.91, and amikacin decreased from 2.27 to 2.13. The overall cephalosporin usage decreased from 19.89 to 15.41. The total antibiotic expenditure had a decline of 20.28%, followed by 14.44% reduction on the percentage of antibiotic expenditure per inpatient. Conclusion: Our study describes the 3-month analysis of antimicrobial usage before and after the implementation of the RASPRO by evaluating several parameters. The antibiotic consumption expressed in DDD/100 patient-days for each antibiotic category has demonstrated that there are different impacts that may be debatable and calls for further evaluation. A decrease in the total antibiotic expenditure has also been reported. However, since our study is a preliminary study, it should be continued by further studies that involve longer study duration to observe further impacts of the program.