{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T19:08:29Z","timestamp":1792523309156,"version":"4.5.0"},"reference-count":48,"publisher":"Elsevier BV","issue":"12","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Infection and Public Health"],"published-print":{"date-parts":[[2025,12]]},"DOI":"10.1016\/j.jiph.2025.102971","type":"journal-article","created":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T23:48:12Z","timestamp":1758152892000},"page":"102971","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":4,"title":["Impact of an antimicrobial stewardship program in primary health care centers in Bahrain \u2013 A 5-year experience"],"prefix":"10.1016","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5500-9905","authenticated-orcid":false,"given":"Jameela","family":"Alsalman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmood","family":"Alawainati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shereen","family":"Haji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5474-568X","authenticated-orcid":false,"given":"Nour","family":"Shamas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"10442","key":"10.1016\/j.jiph.2025.102971_bib1","doi-asserted-by":"crossref","first-page":"2426","DOI":"10.1016\/S0140-6736(24)00876-6","article-title":"The scope of the antimicrobial resistance challenge","volume":"403","author":"Okeke","year":"2024","journal-title":"Lancet"},{"issue":"10459","key":"10.1016\/j.jiph.2025.102971_bib2","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1016\/S0140-6736(24)01867-1","article-title":"Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050","volume":"404","author":"GBD 2021 Antimicrobial Resistance Collaborators","year":"2024","journal-title":"Lancet"},{"issue":"10443","key":"10.1016\/j.jiph.2025.102971_bib3","doi-asserted-by":"crossref","first-page":"2534","DOI":"10.1016\/S0140-6736(24)00878-X","article-title":"Expanding antibiotic, vaccine, and diagnostics development and access to tackle antimicrobial resistance","volume":"403","author":"Laxminarayan","year":"2024","journal-title":"Lancet"},{"issue":"10442","key":"10.1016\/j.jiph.2025.102971_bib4","doi-asserted-by":"crossref","first-page":"2439","DOI":"10.1016\/S0140-6736(24)00862-6","article-title":"Burden of bacterial antimicrobial resistance in low-income and middle-income countries avertible by existing interventions: an evidence review and modelling analysis","volume":"403","author":"Lewnard","year":"2024","journal-title":"Lancet"},{"issue":"4","key":"10.1016\/j.jiph.2025.102971_bib5","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1093\/jac\/dkad034","article-title":"Influence of factors commonly known to be associated with health inequalities on antibiotic use in high-income countries: a systematic scoping review","volume":"78","author":"Harvey","year":"2023","journal-title":"J Antimicrob Chemother"},{"issue":"11","key":"10.1016\/j.jiph.2025.102971_bib6","doi-asserted-by":"crossref","first-page":"837","DOI":"10.3390\/antibiotics9110837","article-title":"Time trends and factors associated with antibiotic prescribing in Swiss primary care (2008 to 2020)","volume":"9","author":"Mart\u00ednez-Gonz\u00e1lez","year":"2020","journal-title":"Antibiotics"},{"issue":"1","key":"10.1016\/j.jiph.2025.102971_bib7","doi-asserted-by":"crossref","first-page":"5040","DOI":"10.1038\/s41598-023-32329-6","article-title":"Impact of an antibiotic stewardship program on antibiotic utilization, bacterial susceptibilities, and cost of antibiotics","volume":"13","author":"Aiesh","year":"2023","journal-title":"Sci Rep"},{"key":"10.1016\/j.jiph.2025.102971_bib8","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1016\/j.ijid.2021.03.035","article-title":"A systematic review of antimicrobial stewardship program implementation in middle eastern countries","volume":"105","author":"Ababneh","year":"2021","journal-title":"Int J Infect Dis"},{"issue":"2","key":"10.1016\/j.jiph.2025.102971_bib9","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2022.53806","article-title":"Association between antimicrobial stewardship programs and antibiotic use globally: a systematic review and meta-analysis","volume":"6","author":"Zay Ya","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"1","key":"10.1016\/j.jiph.2025.102971_bib10","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1111\/jcpt.12610","article-title":"Antibacterials dispensed in the community comprise 85%-95% of total human antibacterial consumption","volume":"43","author":"Duffy","year":"2018","journal-title":"J Clin Pharm Ther"},{"issue":"5","key":"10.1016\/j.jiph.2025.102971_bib11","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.12996","article-title":"The challenge of outpatient antibiotic stewardship","volume":"6","author":"Sayood","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"5","key":"10.1016\/j.jiph.2025.102971_bib12","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.13011","article-title":"Implementation of an antibiotic stewardship initiative in a large urgent care network","volume":"6","author":"Stenehjem","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"2","key":"10.1016\/j.jiph.2025.102971_bib13","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1017\/ice.2014.41","article-title":"Antimicrobial stewardship in outpatient settings: a systematic review","volume":"36","author":"Drekonja","year":"2015","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"3","key":"10.1016\/j.jiph.2025.102971_bib14","article-title":"Antimicrobial stewardship programmes in health-care facilities in low- and middle-income countries: a WHO practical toolkit","volume":"1","author":"World Health Organization","year":"2019","journal-title":"JACAntimicrob Resist"},{"key":"10.1016\/j.jiph.2025.102971_bib15","unstructured":"World Bank. Population, total - Bahrain [Internet]. [cited 2024 Jan 2]. Available from: \u3008https:\/\/data.worldbank.org\/indicator\/SP.POP.TOTL?locations=BH\u3009."},{"key":"10.1016\/j.jiph.2025.102971_bib16","unstructured":"World Bank. UHC service coverage index - Bahrain [Internet]. [cited 2024 Jan 2]. Available from: \u3008https:\/\/data.worldbank.org\/indicator\/SH.UHC.SRVS.CV.XD?locations=BH\u3009."},{"key":"10.1016\/j.jiph.2025.102971_bib17","unstructured":"Kingdom of Bahrain - Ministry of Health [Internet]. [cited 2024 Jan 2]. Primary Health Care. Available from: \u3008https:\/\/www.moh.gov.bh\/services\/PrimaryHealthCare?lang=en\u3009."},{"key":"10.1016\/j.jiph.2025.102971_bib18","unstructured":"Supreme Council of Health, Bahrain. National Health Plan 2016 - 2025 [Internet]. [cited 2024 Jan 2]. Available from: \u3008https:\/\/www.sch.org.bh\/images\/documents\/publications\/National%20Health%20Plan%202016-2025.pdf\u3009."},{"key":"10.1016\/j.jiph.2025.102971_bib19","series-title":"Global action plan on antimicrobial resistance","author":"World Health Organization","year":"2015"},{"key":"10.1016\/j.jiph.2025.102971_bib20","unstructured":"World Health Organization. AWaRe classification of antibiotics for evaluation and monitoring of use, 2023 [Internet]. [cited 2024 Jul 27]. Available from: \u3008https:\/\/www.who.int\/publications\/i\/item\/WHO-MHP-HPS-EML-2023.04\u3009."},{"key":"10.1016\/j.jiph.2025.102971_bib21","unstructured":"WHO. Collaborating Centre for Drug Statistics Methodology. ATC classification index with DDDs2025. \u3008https:\/\/atcddd.fhi.no\/atc_ddd_methodology\/who_collaborating_centre\/\u3009."},{"key":"10.1016\/j.jiph.2025.102971_bib22","unstructured":"United Nations. Political Declaration of the High-level Meeting on Antimicrobial Resistance [Internet]. 2024 [cited 2025 Mar 16]. Available from: \u3008https:\/\/www.un.org\/pga\/wp-content\/uploads\/sites\/108\/2024\/09\/FINAL-Text-AMR-to-PGA.pdf\u3009."},{"key":"10.1016\/j.jiph.2025.102971_bib23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.7573\/dic.2022-8-2","article-title":"How to design and implement an outpatient antimicrobial stewardship programme","volume":"12","author":"Drwiega","year":"2023","journal-title":"Drugs Context"},{"key":"10.1016\/j.jiph.2025.102971_bib24","doi-asserted-by":"crossref","unstructured":"Do inpatient antimicrobial stewardship programs help us in the battle against antimicrobial resistance? Clinical Infectious Diseases. [Internet]. [cited 2025 Jun 26]. Available from: \u3008https:\/\/academic.oup.com\/cid\/article\/73\/11\/e4454\/5871999\u3009.","DOI":"10.1093\/cid\/ciaa1004"},{"issue":"6","key":"10.1016\/j.jiph.2025.102971_bib25","doi-asserted-by":"crossref","first-page":"1792","DOI":"10.1016\/j.japh.2022.06.004","article-title":"Impact of outpatient antimicrobial stewardship guideline implementation in an urgent care setting","volume":"62","author":"Lee","year":"2022","journal-title":"J Am Pharm Assoc (2003)"},{"issue":"1","key":"10.1016\/j.jiph.2025.102971_bib26","doi-asserted-by":"crossref","first-page":"51","DOI":"10.4103\/1817-1737.197779","article-title":"A multifaceted approach to decrease inappropriate antibiotic use in a pediatric outpatient clinic","volume":"12","author":"Al-Tawfiq","year":"2017","journal-title":"Ann Thorac Med"},{"issue":"11","key":"10.1016\/j.jiph.2025.102971_bib27","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1016\/j.cmi.2017.06.011","article-title":"Is antimicrobial stewardship cost-effective? a narrative review of the evidence","volume":"23","author":"Naylor","year":"2017","journal-title":"Clin Microbiol Infect"},{"key":"10.1016\/j.jiph.2025.102971_bib28","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s13756-019-0471-0","article-title":"Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review","volume":"8","author":"Nathwani","year":"2019","journal-title":"Antimicrob Resist Infect Control"},{"key":"10.1016\/j.jiph.2025.102971_bib29","unstructured":"Global antibiotic consumption & use \u2014 GRAM Project [Internet]. [cited 2025 Jun 26]. Available from: \u3008https:\/\/www.tropicalmedicine.ox.ac.uk\/gram\/research\/global-antibiotic-consumption\u3009."},{"issue":"10","key":"10.1016\/j.jiph.2025.102971_bib30","doi-asserted-by":"crossref","first-page":"2572","DOI":"10.1093\/jac\/dkad273","article-title":"Impact of the COVID-19 pandemic on community antibiotic consumption in the EU\/European economic area: a changepoint analysis","volume":"78","author":"Vermeulen","year":"2023","journal-title":"J Antimicrob Chemother"},{"key":"10.1016\/j.jiph.2025.102971_bib31","unstructured":"2025. Global trends in antibiotic consumption during 2016\u20132023 and future projections through 2030. Proceedings of the National Academy of Sciences. \u3008https:\/\/www.pnas.org\/doi\/10.1073\/pnas.2411919121\u3009. 2025."},{"key":"10.1016\/j.jiph.2025.102971_bib32","series-title":"Regional Office for Europe","article-title":"WHO regional office for Europe antimicrobial medicines consumption (AMC) network: AMC data 2020\u20132021","author":"World Health Organization Regional Office for Europe","year":"2023"},{"issue":"6","key":"10.1016\/j.jiph.2025.102971_bib33","doi-asserted-by":"crossref","first-page":"970","DOI":"10.3390\/antibiotics12060970","article-title":"Impact of the COVID-19 pandemic on ambulatory care antibiotic use in Hungary: a population-based observational study","volume":"12","author":"Hambalek","year":"2023","journal-title":"Antibiotics"},{"key":"10.1016\/j.jiph.2025.102971_bib34","doi-asserted-by":"crossref","DOI":"10.3389\/fphar.2023.1067973","article-title":"Antibiotic consumption and antimicrobial resistance in the SARS-CoV-2 pandemic: a single-center experience","volume":"14","author":"Sokolovi\u0107","year":"2023","journal-title":"Front Pharmacol"},{"issue":"6","key":"10.1016\/j.jiph.2025.102971_bib35","doi-asserted-by":"crossref","first-page":"e352","DOI":"10.1097\/IPC.0000000000001071","article-title":"Impact of COVID-19 on outpatient antimicrobial prescribing patterns in New York city","volume":"29","author":"Douglas","year":"2021","journal-title":"Infect Dis Clin Pract (Baltim Md )"},{"key":"10.1016\/j.jiph.2025.102971_bib36","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.2147\/IDR.S502126","article-title":"Rebound of antibiotic use and respiratory infections after resumption of normalcy from COVID-19 in Hong Kong","volume":"18","author":"Ma","year":"2025","journal-title":"Infect Drug Resist"},{"issue":"46","key":"10.1016\/j.jiph.2025.102971_bib37","doi-asserted-by":"crossref","DOI":"10.2807\/1560-7917.ES.2023.28.46.2300604","article-title":"Rebound in community antibiotic consumption after the observed decrease during the COVID-19 pandemic, EU\/EEA, 2022","volume":"28","author":"Ventura-Gabarr\u00f3","year":"2023","journal-title":"Eurosurveillance"},{"key":"10.1016\/j.jiph.2025.102971_bib38","unstructured":"World Health Organization. Bahrain COVID-19 case studies [Internet]. [cited 2025Jun 26]. Available from: \u3008https:\/\/www.moh.gov.bh\/Content\/Upload\/File\/637933076434107917-WHOEMBAH001E-eng.pdf\u3009."},{"issue":"3","key":"10.1016\/j.jiph.2025.102971_bib39","doi-asserted-by":"crossref","first-page":"25","DOI":"10.5339\/qmj.2024.25","article-title":"Severe acute respiratory infections: an epidemiological analysis of surveillance data in Bahrain, 2018\u20132022","volume":"2024","author":"Sayyad","year":"2024","journal-title":"Qatar Med J"},{"issue":"3","key":"10.1016\/j.jiph.2025.102971_bib40","doi-asserted-by":"crossref","first-page":"594","DOI":"10.3390\/antibiotics12030594","article-title":"Is education alone enough to sustain improvements of antimicrobial stewardship in general practice in Australia? Results of an intervention follow-up study","volume":"12","author":"Sangwan","year":"2023","journal-title":"Antibiotics"},{"issue":"7","key":"10.1016\/j.jiph.2025.102971_bib41","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0271812","article-title":"Prospective audit and feedback implementation by a multidisciplinary antimicrobial stewardship team shortens the time to de-escalation of anti-MRSA agents","volume":"17","author":"Yamaguchi","year":"2022","journal-title":"PLoS One"},{"issue":"12","key":"10.1016\/j.jiph.2025.102971_bib42","doi-asserted-by":"crossref","first-page":"848","DOI":"10.3390\/antibiotics9120848","article-title":"Effectiveness and acceptance of multimodal antibiotic stewardship program: considering progressive implementation and complementary strategies","volume":"9","author":"Bouchet","year":"2020","journal-title":"Antibiotics"},{"issue":"9","key":"10.1016\/j.jiph.2025.102971_bib43","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1016\/j.sapharm.2019.03.008","article-title":"Effectiveness of antibiotic stewardship programmes in primary health care settings in developing countries","volume":"16","author":"Brinkmann","year":"2020","journal-title":"Res Soc Adm Pharm"},{"issue":"1","key":"10.1016\/j.jiph.2025.102971_bib44","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1186\/s12879-020-05309-8","article-title":"The effectiveness of a simple antimicrobial stewardship intervention in general practice in Australia: a pilot study","volume":"20","author":"Neels","year":"2020","journal-title":"BMC Infect Dis"},{"key":"10.1016\/j.jiph.2025.102971_bib45","doi-asserted-by":"crossref","first-page":"398","DOI":"10.3389\/fphar.2020.00398","article-title":"Impact of a multifaceted antimicrobial stewardship intervention in a primary health care area: a quasi-experimental study","volume":"11","author":"March-L\u00f3pez","year":"2020","journal-title":"Front Pharmacol"},{"issue":"12","key":"10.1016\/j.jiph.2025.102971_bib46","doi-asserted-by":"crossref","first-page":"1776","DOI":"10.3390\/antibiotics11121776","article-title":"Impact of a primary care antimicrobial stewardship program on bacterial resistance control and ecological imprint in urinary tract infections","volume":"11","author":"Jover-S\u00e1enz","year":"2022","journal-title":"Antibiotics"},{"issue":"1","key":"10.1016\/j.jiph.2025.102971_bib47","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-021-94308-z","article-title":"Assessment of quarter billion primary care prescriptions from a nationwide antimicrobial stewardship program","volume":"11","author":"G\u00f6nen","year":"2021","journal-title":"Sci Rep"},{"issue":"4","key":"10.1016\/j.jiph.2025.102971_bib48","doi-asserted-by":"crossref","DOI":"10.1128\/CMR.00003-20","article-title":"The five ds of outpatient antibiotic stewardship for urinary tract infections","volume":"34","author":"Goebel","year":"2021","journal-title":"Clin Microbiol Rev"}],"container-title":["Journal of Infection and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S187603412500320X?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S187603412500320X?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T05:27:23Z","timestamp":1762666043000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S187603412500320X"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":48,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["S187603412500320X"],"URL":"https:\/\/doi.org\/10.1016\/j.jiph.2025.102971","relation":{},"ISSN":["1876-0341"],"issn-type":[{"value":"1876-0341","type":"print"}],"subject":[],"published":{"date-parts":[[2025,12]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Impact of an antimicrobial stewardship program in primary health care centers in Bahrain \u2013 A 5-year experience","name":"articletitle","label":"Article Title"},{"value":"Journal of Infection and Public Health","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jiph.2025.102971","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 The Author(s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences.","name":"copyright","label":"Copyright"}],"article-number":"102971"}}