Antibiotic Prevalence Study and Factors Influencing Prescription of WHO Watch Category Antibiotic Ceftriaxone in a Tertiary Care Private Not for Profit Hospital in Uganda

Kizito, Mark; Lalitha, Rejani; Kajumbula, Henry; Ssenyonga, Ronald; Muyanja, David; Byakika-Kibwika, Pauline

doi:10.3390/antibiotics10101167

Cited by 9 publications

(9 citation statements)

References 39 publications

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“…Inappropriate use of ceftriaxone, which is a third-generation cephalosporin, can accelerate the emergence of AMR of multidrug-resistant organisms, increase treatment cost, and result in avertable adverse drug effects. In Uganda, one study reported 32% inappropriate use of ceftriaxone in nine health facilities while another study reported a high level of ceftriaxone use at a tertiary care, private not-for-profit hospital [ 67 , 68 ]. A possible explanation for the high prevalence of ceftriaxone could be the ease of use (single daily dose) coupled with its wide spectrum coverage, giving the prescriber a sense of broad-spectrum coverage for most infections encountered in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Point Prevalence Survey of Antibiotic Use across 13 Hospitals in Uganda

Kiggundu¹,

Wittenauer

Waswa³

et al. 2022

Antibiotics

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Standardized monitoring of antibiotic use underpins the effective implementation of antimicrobial stewardship interventions in combatting antimicrobial resistance (AMR). To date, few studies have assessed antibiotic use in hospitals in Uganda to identify gaps that require intervention. This study applied the World Health Organization’s standardized point prevalence survey methodology to assess antibiotic use in 13 public and private not-for-profit hospitals across the country. Data for 1077 patients and 1387 prescriptions were collected between December 2020 and April 2021 and analyzed to understand the characteristics of antibiotic use and the prevalence of the types of antibiotics to assess compliance with Uganda Clinical Guidelines; and classify antibiotics according to the WHO Access, Watch, and Reserve classification. This study found that 74% of patients were on one or more antibiotics. Compliance with Uganda Clinical Guidelines was low (30%); Watch-classified antibiotics were used to a high degree (44% of prescriptions), mainly driven by the wide use of ceftriaxone, which was the most frequently used antibiotic (37% of prescriptions). The results of this study identify key areas for the improvement of antimicrobial stewardship in Uganda and are important benchmarks for future evaluations.

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Section: Discussionmentioning

confidence: 99%

Point Prevalence Survey of Antibiotic Use across 13 Hospitals in Uganda

Kiggundu¹,

Wittenauer

Waswa³

et al. 2022

Antibiotics

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“…This high use of antibiotics in healthcare facilities may be due to various diseases that in-patients suffer from and puts pressure on the prescribers to prescribe these drugs for disease prevention and treatment [61] but may promote the emergence of antibiotic-resistance microbes [62]. The [65]. The high prescription rate of ceftriaxone has a high resistance potential and should not be prescribed routinely [65].…”

Section: Discussionmentioning

confidence: 99%

“…The [65]. The high prescription rate of ceftriaxone has a high resistance potential and should not be prescribed routinely [65]. The over-prescription and use of ceftriaxone also highlight the need for antibiotic prescription guidelines at these facilities per national and international guidelines to reduce its irrational use.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Prescribing Patterns in Adult Patients According to the WHO AWaRe Classification: A Multi-Facility Cross-Sectional Study in Primary Healthcare Hospitals in Lusaka, Zambia

Mudenda¹,

Chomba²,

Chabalenge³

et al. 2022

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Introduction: Indiscriminate prescribing and using of antibiotics have led to the development of antimicrobial resistance (AMR). To reduce this problem, the World Health Organization (WHO) developed the "Access", "Watch", and "Reserve" (AWaRe) classification of antibiotics that promotes antimicrobial stewardship (AMS). In Zambia, there are gaps in practice regarding prescribing of antibiotics based on the AWaRe protocol. This study assessed antibiotic prescribing patterns in adult in-patients in selected primary healthcare hospitals in Lusaka, Zambia. Materials and Methods: This retrospective cross-sectional study was conducted using 388 patient medical files from September 2021 to November 2021, five primary healthcare hospitals namely; Chawama, Matero, Chilenje, Kanyama, and Chipata. Data analysis was performed using the Statistical Package for Social Sciences version 23.

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Section: Introductionmentioning

confidence: 99%

“…One explanation for the increase of resistance could be the overuse of ceftriaxone, especially as peri-operative prophylaxis and through prolonged post-operative administration [ 15 , 16 ]. A recent study from Kampala also showed that up to one out of every two patients admitted to medical wards received a prescription of ceftriaxone [ 15 ]. Further gaps can be found in the lack of locally adapted empirical prescribing guidelines for antimicrobials and the low compliance of clinicians with the national clinical guidelines [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

A case for routine microbial diagnostics: Results from antimicrobial susceptibility testing in post-traumatic wound infections at a Ugandan tertiary care hospital

Jung

Kiwanuka

Mbabazi

et al. 2023

PLOS Glob Public Health

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The global spread of antimicrobial resistance (AMR) poses an increasing challenge for clinicians in Uganda, where microbiological diagnostics are not routinely available or accessible. The aim of this study was to determine pathogen prevalence and antibiotic resistance patterns in patients with wound infections following trauma at a national referral hospital in Kampala, Uganda. In addition, the suitability of currently used empirical treatment options in this setting was evaluated. This prospective, observational study analysed antimicrobial prescriptions, culture results and antimicrobial sensitivity testing (AST) of wound swabs and blood samples from patients with clinical signs of wound infections on the trauma ward. A total of 124 patients (n = 99, 79.8% male) with a median age of 30 years (IQR 23–39) were enrolled between October 2021 and January 2022. Wound infections were classified as nosocomial in 69% of the cases. Pathogens were isolated from 122 wound swabs, yielding 238 bacterial isolates. The most prevalent pathogens were gram-negative bacteria including Escherichia coli (n = 48, 20.2%) and Acinetobacter spp. (n = 43, 18.1%). Empiric treatment consisted of ceftriaxone and gentamicin which was administered to 67.2% (n = 78) and 62.1% (n = 72) of patients, respectively. High rates of antimicrobial resistance could be demonstrated across gram-negative and gram-positive species towards the most common empiric antibiotics. Following the AST results, over 95% (n = 111) of patients required a change of treatment. Our findings demonstrate that current empiric treatment for wound infections is missing its target in hospitalized patients in Kampala. To address the growing problem of AMR in Uganda, there is a pressing need to enhance diagnostic capacity and implement structured antimicrobial stewardship programs.

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Antibiotic Prevalence Study and Factors Influencing Prescription of WHO Watch Category Antibiotic Ceftriaxone in a Tertiary Care Private Not for Profit Hospital in Uganda

Cited by 9 publications

References 39 publications

Point Prevalence Survey of Antibiotic Use across 13 Hospitals in Uganda

Point Prevalence Survey of Antibiotic Use across 13 Hospitals in Uganda

Antibiotic Prescribing Patterns in Adult Patients According to the WHO AWaRe Classification: A Multi-Facility Cross-Sectional Study in Primary Healthcare Hospitals in Lusaka, Zambia

A case for routine microbial diagnostics: Results from antimicrobial susceptibility testing in post-traumatic wound infections at a Ugandan tertiary care hospital

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