Current antibiotic use among hospitals in the sub-Saharan Africa region; findings and implications
Siachalinga, Linda and Godman, Brian and Mwita, Julius C and Sefah, Israel Abebrese and Ogunleye, Olayinka O and Massele, Amos and Lee, Iyn-Hyang (2023) Current antibiotic use among hospitals in the sub-Saharan Africa region; findings and implications. Infection and Drug Resistance, 16. 2179—2190. (https://doi.org/10.2147/IDR.S398223)
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Abstract
Background. The rapid rise in antimicrobial resistance (AMR) globally, impacting on morbidity, mortality and costs with sub-Saharan African countries reporting the greatest burden is a concern. Instigation of antimicrobial stewardship programs (ASPs) can improve antibiotic use in hospitals and reduce AMR. Implementing ASPs requires knowledge of antibiotic utilization against agreed quality indicators with this data obtained from point prevalence surveys (PPS), hence need to document antibiotic utilization patterns in sub-Saharan Africa. Methods. A narrative review to document current utilization patterns, challenges, indicators and ASPs across sub-Saharan Africa based on previous reviews by the authors, supplemented by the considerable knowledge and experience of the co-authors. Results. Results from multiple PPS studies showed a high prevalence of antibiotic use among hospitals, mostly over 50%. Prevalence rates ranged from as low as 37.7% in South Africa to as high as 80.1% in Nigeria. There was also considerable prescribing of broad-spectrum antibiotics which could be due to lack of facilities within hospitals, alongside concerns with co-payments to perform microbiological tests, resulting in empiric prescribing. This is a concern alongside lack of guidelines or adherence to guidelines, which was as low as 4% in one study. Another concern was the high rates of extended prophylaxis to prevent surgical site infections (SSIs), with antibiotics often prescribed for longer than 24 hours, usually multiple doses. Several quality indicators have been used to evaluate antibiotic utilization providing exemplars for the future. Among the initiatives being instigated to improve antibiotic use, ASPs have proved effective. For ASPs to be successful objectives and indicators must be agreed, and regular audits undertaken. Conclusions.Antibiotic prescribing across Africa is characterised by high prevalence, usually empirical. Various prescribing and quality indicators are being employed to assess antibiotic use, and ASPs have shown to improve antibiotic prescribing providing direction to reduce AMR.
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Item type: Article ID code: 84529 Dates: DateEvent13 April 2023Published21 February 2023AcceptedSubjects: Medicine > Pharmacy and materia medica Department: Faculty of Science > Strathclyde Institute of Pharmacy and Biomedical Sciences Depositing user: Pure Administrator Date deposited: 03 Mar 2023 12:44 Last modified: 21 Sep 2024 13:22 URI: https://strathprints.strath.ac.uk/id/eprint/84529