ORIGINAL RESEARCH article
Front. Digit. Health
Sec. Health Technology Implementation
Volume 7 - 2025 | doi: 10.3389/fdgth.2025.1647528
Impact of integrating guidelines into an antimicrobial stewardship smartphone application on outpatient antibiotic prescribing: A segmented interrupted time series analysis
Provisionally accepted
Ahmed A Sadeq1Laila Z Alhaj1Jinan M Shamseddine1Barbara R Conway2Stuart E Bond3Rizwan Ali1William J Lattyak4
Zahir O.E. Babiker1
Mamoon Aldeyab2*- 1Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
- 2University of Huddersfield, Huddersfield, HD1 3DH, West Yorkshire, UK, West Yorkshire, United Kingdom
- 3Mid Yorkshire Teaching NHS Trust, Wakefield, United Kingdom
- 4Scientific Computing Associates Corp, River Forest, IL, United States
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Antimicrobial stewardship (AMS) smartphone applications (apps) have been adopted to promote better antimicrobial prescribing practices. We aimed to evaluate the impact of incorporating an app on AMS metrics and adherence to a local antimicrobial guideline in an outpatient setting. A quasi-experimental, segmented interrupted time series design was used, involving three study phases (pre-intervention: 1st January 2020 to 31st December 2021; implementation: 1st January 2022 to 31st December 2022, and post-intervention: 1st January 2023 to 30th June 2024) in a hospital outpatient setting. The effect of introducing an AMS app incorporating local antimicrobial guidelines on AMS outcomes was measured. A total of 16,453 patients were identified. As per the most parsimonious simple model, the amounts of the following antibiotics, expressed as defined daily dose (DDD) per 100 patient visits, increased significantly during the post-intervention phase: azithromycin (co-efficient 0.297, p= 0.007), co-amoxiclav (co-efficient 2.608, p= 0.042), and nitrofurantoin (co-efficient 0.908, p= 0.003). The trend in fosfomycin use decreased significantly in the post-intervention phase (co-efficient -0.23., p < 0.001). Guideline adherence increased significantly after implementing the AMS app (trend change co-efficient 0.011, p < 0.001). These changes in antibiotic prescribing represent improved guideline adherence, and are aligned with WHO AWaRe ctegorisation recommendations. In conclusion, the app improved the utilization of antibiotic prescribing by increasing adherence to local antimicrobial guidelines, affirming its utility in augmenting AMS in outpatient settings.
Keywords: guidelines, Antimicrobial stewardship (AMS), Smartphone application (App), Antibiotic prescribing, Interrupted time series analysis
Received: 15 Jun 2025; Accepted: 19 Aug 2025.
Copyright: © 2025 Sadeq, Alhaj, Shamseddine, Conway, Bond, Ali, Lattyak, Babiker and Aldeyab. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Mamoon Aldeyab, University of Huddersfield, Huddersfield, HD1 3DH, West Yorkshire, UK, West Yorkshire, United Kingdom
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