INDIAN PEDIATRICS 739 VOLUME 54 __ SEPTEMBER 15, 2017 M isuse of antibiotics is one of the primary reasons for the escalating problem of antibiotic resistance [1]. Several studies have reported high and inappropriate use of antibiotics in neonatal intensive care units (NICU) in India, and recommended implementation of antibiotic policy in these units [2,3]. However, there are no published studies evaluating the impact of antibiotic policy on antibiotic consumption in NICU setting in India in the era of high antimicrobial resistance. In this study, we examined the impact of an antibiotic policy for neonatal sepsis on overall antibiotic consumption in a single NICU. METHODS This study was conducted between January 1st, 2013 and December 31st, 2014 in a rural hospital with 30 NICU beds which caters to both inborn and out-born babies. The antibiotic policy for neonatal sepsis was initiated on January 1st, 2014. A protocol was developed for empirical therapy of neonatal sepsis based on the review of blood culture susceptibility data obtained from NICU between January and December 2013. Ampicillin and gentamicin were considered as first line antibiotics for community acquired infections (CAIs). Combination of amikacin and ciprofloxacin was considered if there was deterioration on first line antibiotics for CAIs and as first line for healthcare associated infections (HAIs). Meropenem was recommended for empiric therapy only in very severe cases of HAIs. Third generation cephalosporins were recommended only when an intracranial infection was suspected. Empirical treatment choices were adjusted subsequently to narrow spectrum antibiotics whenever possible based on culture and antibiotic susceptibility results. Impact of Antibiotic Policy on Antibiotic Consumption in a Neonatal Intensive Care Unit in India DASARATHA RAMAIAH JINKA, # SUMANTH GANDRA, * GERARDO ALVAREZ-URIA, ‡ NURIA TORRE, **DURGESH TADEPALLI AND ## RAGHUPRAKASH REDDY NAYAKANTI From Departments of Pediatrics, * Infectious Diseases, and ## Clinical Microbiology, Rural Development Trust Children’s Hospital, Bathalapalli, Andhra Pradesh,India; # Center for Disease Dynamics, Economics & Policy, New Delhi, India; ** Department of Pediatrics, Rural Development Trust Hospital, Kanekal,AP, India; and ‡ Department of Neonatology, SJD Hospital, Barcelona, Spain. Objective: To study the impact of initiating antibiotic policy on antibiotic consumption in a neonatal intensive care unit (NICU). Methods: This retrospective study was conducted between January, 2013 and December, 2014 in a 30 bed NICU. The antibiotic policy for neonatal sepsis was initiated on January 1st, 2014. The overall antibiotic consumption (Daily Defined Dose [DDD] per 100 patient-days), one year before and one year after the initiation of antibiotic policy was evaluated using interrupted time-series analysis. Results: There was no significant change (12.47 vs. 11.47 DDD/100 patient-days; P = 0.57) in overall antibiotic consumption. A significant increase in the proportion of patients on first-line agents (ampicillin and gentamicin) (66% (n=449) vs. 84% (n=491); P <0.001) and significant decrease in consumption of third generation cephalosporins (1.45 vs. 0.45 DDD/100 patient-days; P =0.002) was observed. Conclusion: Antibiotic policy increased the use of first-line agents and decreased the consumption of third generation cephalosporins. Keywords: Antibiotic resistance, Infection control, Rational prescription. Correspondence to: Dr Dasaratha Ramaiah Jinka, Head, Department of Paediatrics, Rural Development Trust Children’s Hospital, Bathalapalli, Andhra Pradesh, India. jdashrath86@gmail.com. Received: October 06, 2016; Initial review: February 08, 2017; Accepted: June 07, 2017. RESEARCH P H P H P H P H PAPER Accompanying Editorial: Pages 723-25. Standard definitions for “possible sepsis”, “probable sepsis” and “confirmed sepsis” were used. The duration of therapy for “possible sepsis” was 48-72 hours; 5-7 days for “probable sepsis”; 10-14 days for “confirmed sepsis” and 21 days for “meningitis” [4]. The primary outcome was to compare overall antibiotic consumption in the year before and after the initiation of antibiotic policy using WHO’s Anatomical Therapeutic Chemical (ATC)/Defined Daily Dose (DDD) per 100 patient-days [5]. DDD is the average Copyright of Indian Pediatrics 2017 For personal use only. Not for bulk copying or unauthorized posting to listserv/websites