Abstract
Objective: To design, implement, and evaluate the impact of a multidisciplinary Antimicrobial Stewardship Program (ASP) in a tertiary care hospital in rural Sindh.
Methodology: This prospective, quasi-experimental, interventional study was conducted from July 2023 to December 2024 at People’s Medical College Hospital, Nawabshah. It included 3000 adult inpatients (Using Cochran’s formula) receiving systemic antimicrobials. The intervention comprised audit and feedback, formulary restrictions, guideline development, and healthcare professional education. Key outcomes included antimicrobial consumption, prescription appropriateness, resistance trends, and clinical outcomes. Data were analyzed by SPSS v28, with p<0.05 considered significant.
Results: A total of 3,000 patients were analyzed. Post-intervention, defined daily doses (DDD) per 100 patient-days declined significantly across all major antimicrobial classes, notably carbapenems and cephalosporins. Appropriate prescribing improved from 52.5% to 67.3% (p<0.0001). Modest reductions in multidrug-resistant organisms were observed. Clinical outcomes, including average length of stay, mortality, and readmission rates, also improved.
Conclusion: Implementation of ASP led to measurable improvements in antimicrobial use, prescribing behavior, and patient outcomes. These findings demonstrate the feasibility and effectiveness of stewardship programs in resource-limited tertiary care settings. Sustained commitment and institutional support are essential to mitigate antimicrobial resistance and enhance antimicrobial use in low and middle-income countries.

Key words: Antimicrobial Stewardship Program, antimicrobial resistance, prescribing appropriateness, Pakistan.