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British Journal of Medicine and Medical Research, ISSN: 2231-0614,Vol.: 12, Issue.: 3


Antibiotic Use, Cost, and Consumption in Tertiary Hospitals in Lebanon: A Comparative Study Before and After an Implementation of Antibiotic-Restriction Program (ARP)


Alia Allouch1, Hala Sabbah2, Samara Hassan3, Sanaa Sabbah4,5, Nabil Droubi6* and Ibtissam Sabbah6

1Nabih Berri University Hospital, Nabatieh, Lebanon.

2Faculty of Economic Sciences and Business Administration, Lebanese University, Nabatieh, Lebanon.

3Siblin Governmental Hospital, Mount, Lebanon.

4Doctoral School of Literature, Humanities and Social Sciences, Lebanese University, Beyrouth, Lebanon.

5Institute of Social Science, Lebanese University, Saida, Lebanon.

6Faculty of Public Health, Lebanese University, Saida, Lebanon.

Article Information


(1) Crispim Cerutti Junior, Department of Social Medicine, Federal University of Espirito Santo, Brazil.


(1) Maria Todorova-Christova, National Center of Public Health and Analyses, Sofia, Bulgaria.

(2) M. Angeles Calvo Torras, Universidad Autonoma de Barcelona, Spain.

Complete Peer review History:


Aims: To compare the antibiotic use, cost, and consumption before and after an implementation of an antibiotic-restriction program (ARP) in governmental hospitals setting in Lebanon.

Study Design: A retrospective cohort study on hospitalized patients who were prescribed antibiotics prior to, and after the application of the ARP, was conducted over a three month period, between March 2013 and June 2013.

Methodology: The studied population included patients on antibiotic therapy. The sample size that was enrolled was equal to 612 patients prior to ARP and 606 patients after ARP.

Results: The average age of the patients was 34.6±23.5 years, 55.6% of whom were females, and 79.2% had no comorbidity. Respiratory diseases, and gynecological surgeries motivated the antibiotics prescriptions. The physicians prescribed combinations of intravenous antibiotics in 91% of the cases. The most frequently ordered antibiotics were second, third- generation cephalosporins, and penicillin derivatives. After ARP, the rate of restricted antibiotic use decreased by 11% (P<.0001), while the use of gentamicin increased with a potential for increased rates of nephrotoxicity and ototoxicity; Prior to and after the ARP, a microbiological exam was done in 12.6% of cases, and 67.3% of the cases of prescribed antibiotics were sensitive. The expenditure of all, and restricted antibiotics decreased by 22.3% and 9% respectively. The cost savings were US$ 8099 per month. The compliance with the ARP by prescribers was very high (>90%).

Conclusion: The ARP reduces the amount of antibiotic usage, cuts down the healthcare expenditure, and may prevent a higher prevalence of some resistant bacterial strains; it is, therefore, in the interest of policymakers to propose an antimicrobial stewardship program based on mHealth system that allows patients, and healthcare providers an on-line and mobile consultation.

Keywords :

Antibiotic restriction program; governmental hospital; healthcare cost; pre- and post-intervention; Lebanon.

Full Article - PDF    Page 1-15

DOI : 10.9734/BJMMR/2016/22025

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