Antibiotic use and consumption in Freetown, Sierra Leone: A baseline report of prescription stewardship in outpatient clinics of three tertiary hospitals

Lakoh, Sulaiman; John-Cole, Valerie; LUKE, Ronita D.C.; BELL, Nellie; Russel, James; Mustapha, Ayeshatu; Barrie, Umu; Abiri, Onome T.; Coker, Joshua; Kamara, Matilda N; COKER, Freddie J.; Adekanmbi, Olukemi; Kamara, Ibrahim Franklyn; Fofanah, Bobson Derrick; Jiba, Darlinda F.; Adeniji, Adetunji O.; KENNEH, Sartie; Deen, Gibrilla F.; Moon, Troy D.; Yendewa, George A.; Firima, Emmanuel

doi:10.1016/j.ijregi.2023.02.004

Cited by 9 publications

(14 citation statements)

References 23 publications

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“…In keeping with our findings, a recently published study on antibiotic use among suspected and confirmed COVID-19 cases admitted to 35 COVID-19 hospitals in Sierra Leone also documented a high prevalence of antibiotic use, as over half of the patients admitted to these centres received an antibiotic 15. Several other studies conducted in the general patient population including surgical patients have also demonstrated a high prevalence of antibiotic use 22 30–32. Additionally, a multicentre PPS on antibiotic use in Ethiopian hospitals that involved a review of over 1800 patient records documented a high prevalence (63.8%) of antibiotic use 33.…”

Section: Discussionsupporting

confidence: 88%

“…The high usage of antibiotics in Sierra Leone might be a result of habitual practices wherein clinicians prescribe antibiotics with the assumption that patients who access healthcare services in secondary and tertiary hospitals might have superimposed bacterial infections irrespective of the working diagnosis. Furthermore, they might use antibiotics as a safety net due to weak infection prevention and control practices and infrastructures 22…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, they might use antibiotics as a safety net due to weak infection prevention and control practices and infrastructures. 22 Over 10 different types of antibiotics were prescribed to admitted patients across the 26 hospitals. The top five prescribed antibiotics were metronidazole, ceftriaxone, ampicillin, gentamicin and amoxicillin.…”

Section: Discussionmentioning

confidence: 99%

“… 15 Several other studies conducted in the general patient population including surgical patients have also demonstrated a high prevalence of antibiotic use. 22 30–32 Additionally, a multicentre PPS on antibiotic use in Ethiopian hospitals that involved a review of over 1800 patient records documented a high prevalence (63.8%) of antibiotic use. 33 Furthermore, a study conducted in a tertiary hospital in South East Nigeria also recorded a high prevalence of antibiotic use as over two-thirds of the patients surveyed were on at least one antibiotic.…”

Section: Discussionmentioning

confidence: 99%

“…In Sierra Leone, a few studies have been conducted that evaluated the use of antibiotics in hospitals 15 20–22. A recent study conducted by Kamara and colleagues15 documented over 50% prevalence of antibiotic use among suspected and confirmed COVID-19 patients admitted to isolation units and treatment centres.…”

Section: Introductionmentioning

confidence: 99%

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

Kamara,

Kanu,

Maruta

et al. 2023

BMJ Open

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ObjectiveInappropriate use of antibiotics is a major driver of antibiotic resistance. A few studies conducted in Africa have documented that about half of hospitalised patients who receive antibiotics should not have received them. A few hospital-based studies that have been conducted in Sierra Leone have documented a high usage of antibiotics in hospitals. Therefore, we conducted a nationwide point prevalence survey on antibiotic use among hospitalised patients in Sierra Leone.DesignWe conducted a hospital-based, cross-sectional survey on the use of antibiotics using the WHO point prevalence survey methodology.SettingThe study was conducted in 26 public and private hospitals that are providing inpatient healthcare services.ParticipantsAll patients admitted to paediatric and adult inpatient wards before or at 08:00 on the survey date were enrolled.Outcome measuresPrevalence of antibiotic use, antibiotics Access, Watch and Reserve (AWaRe) categorisation, indication for antibiotic use prevalence and proportion of bacteria culture done.ResultsOf the 1198 patient records reviewed, 883 (73.7%, 95% CI 71.1% to 76.2%) were on antibiotics. Antibiotic use was highest in the paediatric wards (306, 85.7%), followed by medical wards (158, 71.2%), surgical wards (146, 69.5%), mixed wards (97, 68.8%) and lowest in the obstetrics and gynaecology wards (176, 65.7%). The most widely prescribed antibiotics were metronidazole (404, 22.2%), ceftriaxone (373, 20.5%), ampicillin (337, 18.5%), gentamicin (221, 12.1%) and amoxicillin (90, 5.0%). Blood culture was only done for one patient and antibiotic treatments were given empirically. The most common indication for antibiotic use was community-acquired infection (484, 51.9%) followed by surgical prophylaxis (222, 23.8%).ConclusionThere was high usage of antibiotics in hospitals in Sierra Leone as the majority of patients admitted received an antibiotic. This has the potential to increase the burden of antibiotic resistance in the country. We, therefore, recommend the establishment of hospital antimicrobial stewardship programmes according to the WHO core components.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Kamara,

Kanu,

Maruta

et al. 2023

BMJ Open

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Antibiotic use by clinical presentation across all healthcare providers in rural Burkina Faso: a healthcare visit exit survey

Valia,

Ingelbeen,

Nassa

et al. 2024

Journal of Antimicrobial Chemotherapy

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Background To guide antibiotic stewardship interventions, understanding for what indications antibiotics are used is essential. Methods In rural Burkina Faso, we measured antibiotic dispensing across all healthcare providers. From October 2021 to February 2022, we surveyed patients in Nanoro district, Burkina Faso, following visits to health centres (3), pharmacies (2), informal medicine vendors (5) and inpatients in health centres. We estimated prevalence of antibiotic use and the proportion of Watch group antibiotics by provider type and by clinical presentation, assessing compliance with WHO’s AWaRe Antibiotic Book. We estimated per capita antibiotic use by multiplying prevalence of antibiotic use, mean DDD per adult treatment course, and the rate of healthcare visits per 1000 inhabitants per day, estimated from a prior household survey. Results Outpatient antibiotic use was more frequent after health centre visits (54.8%, of which 16.5% Watch, n = 1249) than after visits to pharmacies (26.2%, 16.3% Watch, n = 328) and informal medicine vendors (26.9%, 50.0% Watch, n = 349). The frequency of antibiotic use was highest for bronchitis (79.9% antibiotic use, of which 12.6% Watch), malaria (31.9%, 23.1% Watch), gastroenteritis (76.0%, 31.7% Watch), rhinopharyngitis (40.4%, 8.3% Watch) and undifferentiated fever (77.0%, 44.8% Watch). Compliance with WHO AWaRe guidance could have averted at least 68.4% of all Watch antibiotic use in outpatients at health centres. Community-wide, 2.9 DDD (95% CI 1.9–3.9) were used per 1000 adult inhabitants per day. Conclusions Most Watch antibiotic use at community level or primary care deviated from WHO guidance. Antibiotic stewardship should focus on key clinical presentations and include primary care and self-medication.

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Surveillance of antibiotics use in inpatients at Benjamin Mkapa Zonal Referral Hospital in Dodoma, Tanzania: a point prevalence survey

Zimbwe,

Yona,

Chiwambo

et al. 2024

BMJ Open

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ObjectiveTo assess antibiotics prescribing and use patterns for inpatients at Benjamin Mkapa Zonal Referral Hospital (BMH) using the WHO-Point Prevalence Survey (WHO-PPS).DesignA cross-sectional survey.SettingThe Benjamin Mkapa Zonal Referral Hospital, Dodoma, Tanzania.ParticipantsInpatient prescriptions, regardless of whether antibiotics were prescribed (n=286) on the day of PPS.Outcome measuresOur study analysed the prevalence of antibiotic use at BMH for inpatients, the type of antibiotics used, the indications for use and the proportion of oral and parenteral antibiotics. We also assessed prescription-prescribed antibiotics after a positive antimicrobial susceptibility testing (AST) result.ResultsA survey was conducted on 286 prescriptions, which revealed that 30.07% of them included antibiotics. On average, each prescription contained at least 1.6 antibiotics. All prescriptions that included antibiotics were written in generic names, and 77.91% (67/86) of them followed the Standard Treatment Guidelines. Of the prescriptions that included antibiotics, 58.14% (50/86) had a single antibiotic, 20.93% (18/86) had parenteral antibiotics and 79.07% (68/86) had oral antibiotics. Based on AWaRe’s (Access, Watch and Reserve) categorisation of antibiotics, 50% (8/16) were in the Access group, 31.25% (5/16) were in the Watch group, 12.50% (2/16) were in the Reserve group and 6.25% (1/16) were not recommended antimicrobial combinations. Out of 86 prescriptions included antibiotics, only 4.65% showed positive culture growth. However, antibiotics were still prescribed in 29.07% of prescriptions where there was no growth of bacteria, and in 66.28% of prescriptions, antibiotics were prescribed empirically without any requesting of bacteria culture and AST.ConclusionBMH has reduced inpatient Antibiotic Use by half compared with the 2019 WHO-PPS. Adherence to National Treatment Guidelines is suboptimal. Clinicians should use AST results to guide antibiotic prescribing.

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Antibiotic use and consumption in Freetown, Sierra Leone: A baseline report of prescription stewardship in outpatient clinics of three tertiary hospitals

Cited by 9 publications

References 23 publications

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

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

Antibiotic use by clinical presentation across all healthcare providers in rural Burkina Faso: a healthcare visit exit survey

Surveillance of antibiotics use in inpatients at Benjamin Mkapa Zonal Referral Hospital in Dodoma, Tanzania: a point prevalence survey

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