Evaluation of the clinical practice of aminoglycosides use in paediatric patients in Kenya : findings and implications to Low-middle Income Countries

Onyango, Elias Joseph and Okalebo, Faith and Oluka, Margaret and Kinuthia, Rosaline and Achieng, Loice and Godman, Brian and Kurdi, Amanj (2020) Evaluation of the clinical practice of aminoglycosides use in paediatric patients in Kenya : findings and implications to Low-middle Income Countries. JAC-Antimicrobial Resistance, 2 (1). dlz087. ISSN 2632-1823

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    Abstract

    Objectives To evaluate the practice of aminoglycoside (AG) use/monitoring in Kenya, and explore healthcare worker (HCW) perceptions on AG monitoring to identify gaps and opportunities for future improvements given AG’s low therapeutic index. Methods This was a two phase study whereby in phase one we reviewed patients’ medical records at Kenyatta National Hospital (October-December 2016) and interviewed HCWs face to face in phase two. Outcome measures included describing and evaluating the practice of AG use and monitoring and compliance to guidelines. Data were analyzed using descriptive and inferential analysis. Results Overall, out of the 2,318 patients admitted, 192 patients (8.3%) were prescribed AG; of which 102 (53.1%) had AG doses that did not conform to national guidelines. AG-related adverse effects were suspected in 65 (33.9%) patients. Monitoring of AG therapy was performed in only 17 (8.9%) patients; with no therapeutic drug monitoring (TDM), attributed mainly to knowledge and skills gaps and lack of resources. Out of the 28 recruited HCWs, 18 (64.3%) needed training in how to perform and interpret TDM results. Conclusion The practice of using and monitoring AG was sub-optimal raising concerns around potential, avoidable harm to patients. The identified gaps could form the bases for developing strategies to improve AG’ future use not only in Kenya but also in other countries with similar settings and resources.