Current status and future direction of antimicrobial stewardship programs and antibiotic prescribing in primary care hospitals in Zambia

Tools

Makiko, Faustina and Kalungia, Aubrey Chichonyi and Kampamba, Martin and Mudenda, Steward and Shellack, Natalie and Meyer, Johanna Catharina and Bumbangi, Flavien Nsoni and Okorie, Michael and Banda, David and Munkombwe, Derick and Mutwale, Ilunga and Chizimu, Joseph Yamweka and Kasanga, Maisa Anita and Masaninga, Freddie and Muhimba, Zoran and Lukwesa, Chileshe and Chanda, Duncan and Chanda, Raphael and Mpundu, Mirfin and Mwila, chiluba and St. Claire Jones, Anja and Newport, Melanie and Chilengi, Roma and Sefah, Israel Abebrese and Godman, Brian (2025) Current status and future direction of antimicrobial stewardship programs and antibiotic prescribing in primary care hospitals in Zambia. JAC-Antimicrobial Resistance. ISSN 2632-1823 (In Press)

[thumbnail of Makiko-etal-JACAR-2025-Current-status-and-future-direction-of-antimicrobial-stewardship] Text. Filename: Makiko-etal-JACAR-2025-Current-status-and-future-direction-of-antimicrobial-stewardship.pdf
Accepted Author Manuscript
Restricted to Repository staff only until 1 January 2099.
Download (873kB) | Request a copy

Abstract

Background: Antimicrobial Stewardship Programs (ASPs) intended to optimize antibiotic use will be more effective if informed by the current status and patterns of antibiotic utilization. In Zambia's primary healthcare (PHC) settings, data on ASPs and antibiotic utilisation were inadequate to guide improvements. As a first step, this study assessed antibiotic prescribing and ASP core elements among PHC first-level hospitals (FLHs) in Zambia. Methods: A point-prevalence survey was conducted at the five FLHs in Lusaka using the Global-PPS® protocol. Hospital ASP core elements evaluated included hospital leadership commitment, accountability, pharmacy expertise, action, tracking, reporting, and education. Results: Antibiotic use prevalence was 79.8% (146/183). A total of 220 antibiotic prescription encounters were recorded among inpatients, with ceftriaxone (J01DD04, Watch) being the most (50.0%) prescribed. Over 90.0% (202) of the antibiotic prescriptions targeted suspected community-acquired infections, but only 36.8% (81) were compliant with national treatment guidelines. ASP core element implementation was 36.0% (16.2/45), with only two hospitals achieving over 50.0%. The most deficient core elements were accountability, action, tracking, and reporting. Conclusions: ASP implementation in Zambia’s FLHs providing PHC was suboptimal, with high antibiotic prescribing rates, frequent use of broad-spectrum Watch group antibiotics, and low compliance with national treatment guidelines. As key ways forward, ASPs in Zambia’s PHC require strengthening by adapting the WHO AWaRe recommendations and improving accountability, actions, tracking, and reporting antibiotic use to improve stewardship practice and reduce AMR.

CORE (COnnecting REpositories)