Antibiotic use in urological surgeries: a six years review at Muhimbili National Hospital, Dar es salaam-Tanzania

Abstract

IntroductionAntimicrobial prophylaxis for urologic procedures is a major issue, as potential advantages of antibiotic administration should be carefully weighed against potential side effects, microbial resistance, and health care costs. This study aimed to review a six years trend of antibiotic use in urological surgeries at Muhimbili National Hospital (MNH) being an experience in a typical third world environment.MethodsThis was a six years hospital based descriptive, retrospective study conducted of which all case notes of urological patients operated on in between January 2007 to December, 2012 were reviewed by using a structured data collecting tool. The data were analyzed using SPSS software.ResultsMale patients were the majority at 62% (450). The age range was 0 - 90 years, with a mean of 30 ± 22.09. Among the urological surgeries done at MNH 86.5% (628) received prophylactic antibiotics regardless of the type surgery done. Majority 63.7% (463) received antibiotics during induction. Ceftriaxone was the commonly given antibiotic regardless of the type of urological surgery done. Most of patients (86.4%) were given antibiotics for five days regardless whether it was for prophylactic or treatment intention.ConclusionAntibiotic use is still a challenge at our hospital with over use of prophylactic antibiotics without obvious indications. Prolonged use of prophylactic antibiotics beyond five days was the main finding. Ceftriaxone was the most given antibiotic regardless of the urological surgery done and its level of contamination. Antibiotic stewardship needs to be addressed urgently to avoid serious drug resistances leaving alone the cost implication.

Ceftriaxone use in a tertiary care hospital in Kilimanjaro, Tanzania: A need for a hospital antibiotic stewardship programme

“…This is a prolonged antibiotic prophylaxis constituting an unnecessarily excessive antibiotic exposure, which is an important driver of AMR emergence and spread. Similar observations were seen from the hospital in Dar es Salaam regarding use of ceftriaxone for prophylaxis where 86.4% of patients were put on post operative ceftriaxone prophylaxis for up to five days in the majority of elective, clean surgeries[8] and for surgeries involving thyroidectomy (58.2%) and cystectomy (47.8%) [28]. Prolonged surgical ceftriaxone prophylaxes are also observed in a tertiary care hospital in Ethiopia where (94%) had post operative prophylaxis and (70%) used ceftriaxone [29].…”

“…It has an advantage of a wide coverage of pathogens, easy administration as it is once daily dosing–limiting nursing time needed and a low cost compared to many antibiotics. [21] [22][23] Other studies have as well shown a relatively similar extent of use to the current study; for instance, in a study from a tertiary care hospital in Dar es Salaam where ceftriaxone use as urological surgical prophylaxis was 46.1% [8] and in Nigeria ceftriaxone use for a suspected systemic infection was 42.3% [24] and even higher use in Ethiopia empiric ceftriaxone use was 58% [25] presumptive diagnoses of pneumonia, meningitis and sepsis led to ceftriaxone use in 59.3% [12] and the utilization rate of ceftriaxone was found to be high with a point prevalence of 59% where ceftriaxone was empirically used in 79.5% of cases [5]. Thus, generally, the observed ceftriaxone use in the present study as is in other studies is irrationally high as this drug (and as well, other cephalosporins) should only be used as a life saving drug against confirmed severe infections and not prescribed routinely.…”

“…Another indication for cephalosporins should be in confirmed resistance to first and second line antibiotics. Nonchalant ceftriaxone prescription habits by Tanzanian clinicians has been observed to be a common practice in many clinical settings[8] which warrants immediate intervention through antimicrobial stewardship that can monitor adherence to prescription guidelines.…”

“…However, ceftriaxone has often inappropriately and excessively been prescribed in clinical settings especially where there is lack of clear diagnosis[6,7]. Although ceftriaxone can be used as prophylaxis in certain situations, in a National Hospital in Tanzania, ceftriaxone was the most given prophylactic antibiotic regardless of the urological surgery done and its level of contamination[8]. The impact of irrational use of ceftriaxone on development of resistance to third-generation cephalosporins among clinical strains of Enterobacteriacea and other non- enteric bacteria is well known[9–11] and is one of the emerging global public health issues, particularly in LMICs [7,12].…”

Prescription and non-prescription antibiotic dispensing practices in part I and part II pharmacies in Moshi Municipality, Kilimanjaro Region in Tanzania: A simulated clients approach

“…Antimicrobials are overused due to poor adherence to TFDA’s dispensing rules and regulations, poor public health facility antibiotic prescribing, and inappropriate public demand. [ 43 , 44 ]…”