Impact of an antimicrobial stewardship program in primary health care centers in Bahrain – A 5-year experience

BACKGROUND: Antimicrobial misuse globally challenges healthcare by driving resistance, escalating costs, and worsening outcomes. Antimicrobial stewardship (AMS) programs optimize use. This prospective interventional study outlines a five-year antimicrobial stewardship program (ASP) in Bahrain's primary health care (PHC) facilities. METHODS: A prospective interventional study was conducted in Bahrain's governmental PHC centers to evaluate the impact of a newly implemented ASP on antimicrobial use and cost. Starting in 2015, the ASP included a situational analysis of prescribing patterns and resources. A multidisciplinary team was formed to guide AMS activities, develop educational programs, establish clinical guidelines, create an electronic prescribing reporting system, and provide feedback on prescribing trends. The study analyzed antimicrobial prescription order reports and evaluated all antimicrobials prescribed between January 2016 and September 2021, assessing antimicrobial prescription per 1000 inhabitants, defined daily doses (DDD) per 1000 inhabitants, and antimicrobial costs. RESULTS: A total of 2032, 653 prescription were ordered between January 2016 and September 2021, with penicillins (68. 74 %), cephalosporins (18. 13 %), and antiparasitics (9. 43 %) being the most common. Over 70 % of the PHC prescriptions were from the WHO-recommended Access category for the whole study period. After AMS interventions, prescriptions decreased 4. 5-fold, from 67. 6 to 15. 1 prescriptions per 1000 inhabitants, with statistically significant reductions (P < 0. 001) in all antimicrobial classes except nitrofurantoin. The DDD/1000 inhabitants, and cost also decreased significantly (P < 0. 001), saving around 4. 1 million Bahraini Dinars, (10. 97 million). CONCLUSIONS: The first published country wide ASP in primary health care in the Eastern Mediterranean significantly reduced antimicrobial prescriptions and DDD/ 1000 inhabitants. Leadership support, multifaceted interventions, and active multidisciplinary participation are key to sustaining and improving outcomes at a country scale. Further analysis can identify additional gaps and necessary system changes.