Assessment of prescribing practices at the primary health care facilities in Botswana with an emphasis on antibiotics; findings and implications

Mashalla, Yohana and Setlhare, Vincent and Massele, Amos and Sepako, Enoch and Tiroyakgosi, Celda and Kgatlwane, Joyce and Chuma, Mpo and Godman, Brian (2017) Assessment of prescribing practices at the primary health care facilities in Botswana with an emphasis on antibiotics; findings and implications. International Journal of Clinical Practice. ISSN 1368-5031 (In Press)

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    Abstract

    Background and Aims: Inappropriate drug prescribing has increased especially in developing countries where systems for monitoring medicine use are not well developed. This increases the rate of antimicrobial resistance. The study aim was to assess the prescribing patterns among urban primary health facilities in Botswana to provide future guidance including developing future quality indicators. Methods: Retrospective data from patients’ records between January – December 2013 in 19 clinics were collected in a cross-sectional study. The WHO/INRUD indicators were used to assess prescribing patterns in the study clinics. Results: Average number of drugs per prescription was 2.8; 78.6% of the prescribed antibiotics were by INN and 96.1% complied with the Botswana Essential Drugs List. Overall rate of antibiotic prescribing was high (42.7%) with 14.7%, 5.9% and 1.3% of prescriptions having two, three and four antibiotics respectively. Systemic antibiotics (J01C) were most (45.1%) commonly prescribed of which amoxicillin accounted for (28.4%) and metronidazole 14.4% of all antibiotic prescriptions. There was low use of co-amoxiclav (0.3% of all antibiotic prescriptions). Third generation cephalosporins and macrolides accounted for 9.8% and 6.2% of antibiotic prescriptions respectively, with no prescribing of fluoroquinolones. The majority of indications (87%) for antibiotic prescriptions were according to ICD classification. Conclusions: While most indications for antibiotic prescriptions were based on signs and symptoms according to ICD, antibiotic prescribing rates were high with some conditions not requiring antibiotics because they are viral infections. There is a need to further improve prescribing practices through induction and training of in-service prescribers. An effective management tool for monitoring antibiotic prescribing practices at PHC facilities should be designed and implemented, including developing robust quality indicators.