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Warangkhana Wanla,1 Wasan Katip,2,3 Sakon Supakul,2 Porntipa Apiwatnakorn,4 Sompong Khamsarn1 1Department of Pharmacy, Lamphun Hospital, Lamphun, Thailand; 2Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; 3Pharmaceutical Care Training Center (PCTC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; 4Department of Internal Medicine, Lamphun Hospital, Thailand Background: Gram-negative bacteria are becoming increasingly resistant to carbapenems and are related to the use of carbapenems. Thus, the main objective of this study was to compare the appropriateness of prescribing carbapenem before and after using an antimicrobial restriction system without infectious diseases consultation. Materials and methods: A retrospective cross-sectional before and after study was conducted in Lamphun Hospital to limit the prescription of carbapenems. Data were obtained by a review of the medical records and electronic databases from the period September 2014 to January 2015 (before) and from September 2015 to January 2016 (after). Results: A total of 360 antibacterial prescriptions were analyzed. The appropriateness of prescribing was higher after using the antimicrobial restriction (55.0%) than before using the antimicrobial restriction system (38.3%; p=0.001). The amount of carbapenem in the defined daily dose per 1,000 bed days increased by 3.48% after using the antimicrobial restriction system when compared with before using the antimicrobial restriction system, which was not statistically significant (p=0.611). The incidence rates of nosocomial infections caused by resistance of Enterobacteriaceae to ertapenem before and after the intervention to limit antimicrobial therapy was found to have decreased from 4.80 to 0.95 infections per 1,000 patient days, respectively (p=1.00). The expenditure for carbapenems in the average value of baht per patient was found to have decreased by 36.33% after using the antimicrobial restriction system when compared with before using the antimicrobial restriction system (p=0.001). Conclusion: These results suggest that antimicrobial restriction systems can increase the appropriateness of prescribing antibiotics. The expenditure for carbapenem was found to decrease after using the antimicrobial restriction system when compared with before using the antimicrobial restriction system, even without infectious diseases consultation. However, the amount of carbapenem in the defined daily dose per 1,000 bed days was not found to reduce after using the antimicrobial restriction system. Keywords: antimicrobial restriction system, appropriate prescribing, carbapenem use, DDD

Objective: To generate epidemiological information regarding antibiotic use and antimicrobial resistance (AMR) in targeted communities for use by the Thailand AMR Containment and Prevention Program., Material and Method: A survey of antibiotics sold by 215 grocery stores and retail shops located in the target communities was done by the local people who were instructed to purchase specified antibiotics and to present to such stores and shops with symptoms of sore throat, backache, common cold, acute diarrhea, inflamed uterus, and dysuria. The purchased drugs were then identified and recorded. Contamination of extended-spectrum β-lactamase (ESBL)-producing E. coli was identified in 174 samples of foods and open water sources collected from the target communities. Carriage of ESBL-producing E. coli in gastrointestinal tracts of 534 adults living in the target communities was performed by stool sample culture. One thousand three hundred one patients with upper respiratory infection (URI) and 235 patients with acute diarrhea who attended the tambon health promoting hospitals located in the target communities were monitored for their clinical outcomes of treatments. The patients with URI and acute diarrhea with no indication of antibiotic received symptomatic treatments as appropriate and they were followed via telephone contact every few days until all symptoms related to URI and acute diarrhea disappeared. The data were analyzed by descriptive statistics., Results: Antibiotics were sold to the local people who were presenting with common ailments at many grocery stores and retail shops in their respective communities. In almost all cases, antibiotics were inappropriately given. Overall prevalence of ESBL-producing E. coli contamination in foods and open water sources was 26.4%. ESBL-producing E. coli was isolated from fresh meat and open water sources in many samples. Overall prevalence of ESBL-producing E. coli carriage in gastrointestinal tracts of the adults cultured was 66.5%. All patients with URI and acute diarrhea who had no indication of antibiotics and did not receive antibiotics had either cure or favorable response within seven days of start of symptomatic treatment., Conclusion: Antibiotics are widely available and are inappropriately sold and given by grocery stores and retail shops located within local communities in Thailand. Antibiotic-resistant bacteria commonly and freely circulate within the community. Patients with URI and acute diarrhea with no indication for antibiotic therapy can be treated without antibiotics. Findings and observations from this study will be used as part of a social marketing campaign on prevention and containment of AMR to educate people living within communities in Thailand.