Authors’ contributions: Francisco Alves Farias-Filho contributed to project management, contributed to literature search, writing of the abstract, introduction, methodology, discussion, interpretation and description of results, preparation of tables, conclusions, review and statistics. Philipe Vieira Souza contributed to literature search, writing of the abstract, introduction, methodology, discussion, interpretation and description of results, preparation of tables, conclusions, review and statistics. Susana Nunes da Rocha Nascimento contributed to literature search, writing of the abstract, introduction, methodology, discussion, interpretation and description of results, preparation of tables, conclusions, review and statistics. Rafaela de Carvalho Rodrigues contributed to literature search, writing of the abstract, introduction, methodology, discussion and review. Mariana Martins Gonzaga do Nascimento contributed to project administration, contributed to literature search, writing of the abstract, introduction, methodology, discussion, interpretation and description of results, preparation of tables, conclusions, review and statistics. Vinicius de Frias Carvalho contributed to literature search, writing of the abstract, introduction, methodology, discussion, interpretation and description of results, preparation of tables, conclusions, review and statistics. All authors approved the final version to be published and are responsible for all aspects of the work, including ensuring its accuracy and integrity.

Abstract

Background and objectives: Antimicrobial resistance is considered one of the biggest global health challenges of the 21^st century.  Anti-infectives are the most frequently used medications in Neonatal Intensive Care Units, and their misuse and overuse facilitate the selection of infections caused by multidrug-resistant organisms and increase the risk of adverse effects. In this context, the aim of this study was to assess the effectiveness of a multi-step antimicrobial stewardship approach in a Neonatal Intensive Care Unit. Methods: This quasi-experimental longitudinal study used a pre-test/post-test design to evaluate the implementation of antimicrobial stewardship interventions delivered in four stages. In stage I, the profile of newborns was mapped. In Stage II, pharmacotherapeutic protocols for parenteral medications were developed. In Stage III, parenteral medication management for the Neonatal Intensive Care Unit was implemented. In Stage IV, an electronic dosage calculator was integrated into the Computerized Physician Order Entry. In Stage V, physicians and professionals responsible for dispensing medications were trained by clinical pharmacists. Effectiveness was assessed by comparing the incidence of prescribing errors before and after implementation. Results: There were 513 prescriptions during the implementation period: 332 for vancomycin, 149 for cefepime and 42 for piperacillin-tazobactam. A statistically significant reduction in the incidence of prescription errors involving dose and infusion time was observed. Conclusion: The implementation of multiple pharmacy-based antimicrobial stewardship interventions improved the safety profile of antimicrobial prescriptions.