A Systematic Review of Pharmacist-Led Antimicrobial Stewardship Programs in Sub-Saharan Africa

Abstract

Background. The misuse of antibiotics contributes significantly to antimicrobial resistance (AMR). Higher treatment costs, longer hospital stays, and clinical failure can all result from AMR. According to projections, Africa and Asia will bear the heaviest burden of AMR-related mortalities in the coming years. Antimicrobial stewardship (AMS) programmes are therefore critical in mitigating the effects of AMR. Pharmacists may play an important role in such programmes, as seen in Europe and North America, but the impact, challenges, and opportunities of pharmacist-led antimicrobial stewardship interventions in Sub-Saharan African hospitals are unknown. The purpose of this systematic review was to assess the impact, challenges, and opportunities of pharmacist-led antimicrobial stewardship interventions in Sub-Saharan African hospitals. Methods. The Joanna Briggs Institute (JBI) guidelines were used to search for peer-reviewed pharmacist-led studies based in hospitals in Sub-Saharan Africa that were published in English between January 2015 and January 2021. The PubMed, Embase, and Ovid databases were used. Results. Education and training, audits and feedback, protocol development, and ward rounds were identified as primary components of pharmacist-led antimicrobial stewardship interventions in Sub-Saharan Africa. The pharmacist-led antimicrobial interventions improved adherence to guidelines and reduced inappropriate prescribing, but were hampered by a lack of laboratory and technological support, limited stewardship time, poor documentation, and a lack of guidelines and policies. Funding, mentorship, guidelines, accountability, continuous monitoring, feedback, multidisciplinary engagements, and collaborations were identified as critical in the implementation of pharmacist-led antimicrobial stewardship programmes. Conclusions. These findings suggest that pharmacists in Sub-Saharan African hospitals can successfully lead antimicrobial stewardship programmes but their implementation is limited by lack of mentorship, accountability, continuous monitoring, feedback, collaborations, and poor funding.

Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future

“…The number of PPS studies have grown across Africa over time ( Table S1 ) despite concerns with available resources and personnel, providing future guidance, and this acceleration will continue. In addition, we are seeing the number of successful ASPs increase across Africa ( Table 3 ), despite again initial concerns regarding available financial resources and personnel to conduct ASPs in LMICs, providing exemplars to others [ 128 , 132 , 137 , 138 ]. This will continue as part of NAPs to reduce rising AMR rates across Africa [ 2 , 70 ].…”

“…The principal approach was a narrative review of recent ASPs that had been instigated across Africa. This built on recent reviews coupled with additional studies known to the co-authors from 2013 onwards [ 132 , 137 , 138 ]. The objective was again to provide guidance to African countries planning ASPs rather than undertaking a systematic review of the studies.…”

“…This though is also starting to change among African countries as well as among other LMICs [ 111 , 132 , 133 , 134 , 135 , 136 , 137 ]. We are likely to see more ASPs being instigated across Africa and beyond as part of NAPs to reduce AMR, enhanced by the availability of toolkits from the WHO and others [ 67 , 70 , 132 , 137 , 138 , 139 , 140 ].…”

Evaluation of Healthcare Students’ Knowledge on Antibiotic Use, Antimicrobial Resistance and Antimicrobial Stewardship Programs and Associated Factors in a Tertiary University in Ghana: Findings and Implications

“…One of the five strategies to reduce the impact of AMR in the Global Action Plan is the need to optimize antimicrobial use through the implementation of antimicrobial stewardship programs (ASPs) [ 27 , 28 , 29 ]. Ghana, similar to other African countries, has developed its NAP and is currently implementing a range of agreed activities [ 30 , 31 , 32 ], with the goal to improve future antibiotic utilisation, reduce possible side-effects from antibiotics as well as reduce AMR [ 18 , 19 , 33 , 34 , 35 , 36 , 37 , 38 ].…”

“…However, there are concerns with manpower and resource issues affecting the sustainability of interventions, and knowledge gaps among practitioners, in low- and middle-income countries (LMICs) [ 39 , 40 , 41 , 42 , 43 ]. This is starting to be addressed in Africa, and will continue given the high and rising rates of AMR particularly in sub-Saharan Africa as well as increasing use of ‘Watch’ and ‘Reserve’ antibiotics [ 2 , 14 , 35 , 37 , 38 ]. The knowledge of healthcare students regarding antibiotics and AMR is a key factor to improving antimicrobial utilisation as they will play an important role in the future in either the prescribing or dispensing of antimicrobials across sectors; alternatively, advising key stakeholders including physicians and patients regarding their use [ 8 , 44 , 45 , 46 ].…”