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IMPLEMENTATION OF AN ANTIBIOTIC RESTRICTION FORMULARY AND THE IMPACT ON CONSUMPTION IN A ROMANIAN HOSPITAL: A THREE-YEAR RETROSPECTIVE STUDY

SORINA HÎNCU 1,2#, MIRUNA-MARIA APETROAEI 1*, MIHAELA CRISTINA NEGULESCU 1,2, ALEXANDRU BLIDARU 1#, MANUELA GHICA 1, DENISA IOANA UDEANU 1,3

1 “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia Street, 020956, Bucharest, Romania
2 “Fundeni” Clinical Institute, 258 Fundeni Street, 022328, Bucharest, Romania
3 “Marius Nasta” Institute of Pneumophthisiology, 90 Viilor Street, 050159, Bucharest, Romania

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Antimicrobial resistance is a growing public health challenge exacerbated by excessive antibiotic use in hospitals. Antimicrobial stewardship programs (AMS) aim to optimise antibiotic prescribing to curb resistance. This study evaluates the impact of implementing a restriction formulary on antibiotic consumption in a Romanian hospital over three years. A retrospective analysis was conducted at Fundeni Clinical Institute in Bucharest from 2022 to 2024. Antibiotic consumption was quantified using the Defined Daily Dose (DDD) per 100 patient-days. The study compared antibiotic use before (2022) and after (2023 - 2024) the implementation of a restriction formulary in December 2022. Statistical analyses assessed trends in antibiotic consumption across different hospital wards. Following the formulary’s implementation, overall consumption of reserve antibiotics, including carbapenems and glycopeptides, declined, while narrower-spectrum agents, such as ceftazidime-avibactam and ertapenem, increased. The intensive care unit and haematology wards had the highest antibiotic usage. Although the formulary reduced the prescription of last-line antibiotics, total antibiotic consumption remained stable (p = 0.7). The restriction formulary effectively optimised antimicrobial selection, reducing the overuse of broad-spectrum antibiotics while promoting targeted therapies. However, continued monitoring is necessary to prevent resistance in newly preferred antibiotics and ensure long-term efficacy.