Antibiotic Use Among Hospitalized Patients in Africa: A Systematic Review of Point Prevalence Studies

Abstract

Background There is paucity of data describing the rate and quality indices of antibiotics used among hospitalized patients at continental level in Africa. This systematic review evaluated the pooled prevalence, indications, and types of antibiotics used in hospitals across Africa. Methods Three electronic databases, PubMed, Scopus, and African Journals Online (AJOL), were searched using search terms. Point prevalence studies of antibiotic use in inpatient settings published in English language from January 2010 to November 2022 were considered for selection. Additional articles were identified by checking the reference list of selected articles. Results Of the 7254 articles identified from the databases, 28 eligible articles involving 28 studies were selected. Most of the studies were from Nigeria (n = 9), Ghana (n = 6), and Kenya (n = 4). Overall, the prevalence of antibiotic use among hospitalized patients ranged from 27.6 to 83.5% with higher prevalence in West Africa (51.4–83.5%) and North Africa (79.1%) compared to East Africa (27.6–73.7%) and South Africa (33.6–49.7%). The ICU (64.4–100%; n = 9 studies) and the pediatric medical ward (10.6–94.6%; n = 13 studies) had the highest prevalence of antibiotic use. Community-acquired infections (27.7–61.0%; n = 19 studies) and surgical antibiotic prophylaxis (SAP) (14.6–45.3%; n = 17 studies) were the most common indications for antibiotic use. The duration of SAP was more than 1 day in 66.7 to 100% of the cases. The most commonly prescribed antibiotics included ceftriaxone (7.4–51.7%; n = 14 studies), metronidazole (14.6–44.8%; n = 12 studies), gentamicin (n = 8 studies; range: 6.6–22.3%), and ampicillin (n = 6 studies; range: 6.0–29.2%). The access, watch, and reserved group of antibiotics accounted for 46.3–97.9%, 1.8–53.5%, and 0.0–5.0% of antibiotic prescriptions, respectively. The documentation of the reason for antibiotic prescription and date for stop/review ranged from 37.3 to 100% and 19.6 to 100%, respectively. Conclusion The point prevalence of antibiotic use among hospitalized patients in Africa is relatively high and varied between the regions in the continent. The prevalence was higher in the ICU and pediatric medical ward compared to the other wards. Antibiotics were most commonly prescribed for community-acquired infections and for SAP with ceftriaxone, metronidazole, and gentamicin being the most common antibiotics prescribed. Antibiotic stewardship is recommended to address excessive use of SAP and to reduce high rate of antibiotic prescribing in the ICU and pediatric ward.

Antibiotic prescribing to inpatients in Limpopo, South Africa: a multicentre point-prevalence survey

“…In our study, the proportion of antibiotic prescriptions targeting specific pathogen(s) was 3.4%, lower than global levels (9.8% to 22.3%) [ 7 , 8 , 26 ], as well as previous South African studies (8.3% to 28.8%) [ 38 , 40 ]. The low-targeted prescribing observed together with low specimen collection (11.9%) and fewer results (45.2%) in our study may be attributable to a lack of point-of-care diagnostics and inadequate laboratory capacity, which may result in inappropriate diagnosis and antibiotic therapy [ 1 , 14 , 15 ].…”

“…Globally, one in three hospitalised patients receives an antibiotic, however there is global variance, with low and middle-income countries having higher ABU than high-income countries [ 7 , 8 ] and one in every two hospitalised patients in SSA receiving an antibiotic [ 1 , 8 , 9 ]. The primary cause of high ABU in SSA, in particular, can be attributed to limited hospital antibiotic stewardship programme (ASP) implementation [ 10 – 13 ], inappropriate prescribing (e.g., unnecessary prescribing, inappropriate selection when an antibiotic is indicated, and incorrect dosing, formulation, route of administration and treatment duration) and empirical prescribing due to a lack of or non-adherence to treatment guidelines and limited microbiological testing due to inadequate laboratory facilities, resulting in a vicious cycle of a causal-effect relationship between ABU and ABR development [ 1 , 14 , 15 ].…”

Antibiotic use among hospitalised patients in Sierra Leone: a national point prevalence survey using the WHO survey methodology

“…This is not unique to Sierra Leone A recent systematic review on antibiotic use among hospitalised patients in Africa reported limited data on culture and sensitivity to guide antibiotic selection. 40 The low utilisation of culture and sensitivity in hospitals in Sierra Leone reflects the lack of laboratory capacity for microbiology methods.…”

Surgical Antibiotic Prophylaxis: A Proposal for a Global Evidence-Based Bundle

“…There are few data describing the rate and quality indices of antibiotics used in hospitalised patients in LMICs especially in Africa. However, the few data show that the prevalence of antibiotic use in hospital settings in Africa is higher than the prevalence reported in hospital settings in the other continents [43]. Broad-spectrum antibiotics such as ceftriaxone and fluoroquinolones are antibiotics commonly prescribed in hospitalised patients in Africa [43].…”

“…However, the few data show that the prevalence of antibiotic use in hospital settings in Africa is higher than the prevalence reported in hospital settings in the other continents [43]. Broad-spectrum antibiotics such as ceftriaxone and fluoroquinolones are antibiotics commonly prescribed in hospitalised patients in Africa [43]. SAP is the second most common indication for antibiotic use in African hospital settings.…”