Assessment of the appropriateness of antibiotic prescriptions in Lesotho public hospitals: a novel methodology based on principles of antibiotic prescribing

Abstract

The study primarily aimed at assessing the appropriateness of antibiotic prescriptions in a section of public health institutions in Lesotho using an assessment tool formulated from principles of antibiotic prescribing. Relevant data on procedures of infection diagnosis and prescribed antibiotics were collected from both inpatient and outpatient case reports for a one-month period in five public hospitals in Lesotho. These were analyzed for the appropriateness of the prescribed antibiotics. Prescription appropriateness assessment was based on conformities of prescribed antibiotics to criteria developed from pertinent principles of antibiotic prescribing. Assessed prescriptions, 307 inpatient and 865 outpatient prescriptions in total, were classified into categories of appropriateness based on extents to which they satisfied conditions defined by combinations of criteria in the assessment tool. Antibiotic prescriptions from inpatient and outpatient departments of study site hospitals were categorized into groups of different degrees of appropriateness. A total of 32.2% inpatient prescriptions and 78.4% outpatient prescriptions assessed were appropriately written for the empiric treatment of infections for which bacterial pathogens were considered absolute or possible etiologies. The use of prescription assessment tools based on principles of antibiotic prescribing is a feasible option of assessing the appropriateness of antibiotic prescriptions, particularly in low-income countries where expert panels cannot be formed.

Evaluation of antibiotic prescriptions and use in under-five children in Ibadan, SouthWestern Nigeria

“…In Nigeria and many other developing countries, research assessing appropriateness of antibiotic prescriptions and usage in accordance with principles of antibiotic prescribing is scarce. This study therefore aimed at evaluating appropriateness of antibiotic prescriptions for under-five children in selected secondary and tertiary healthcare facilities in Ibadan, Oyo state, SouthWestern Nigeria, using antibiotic prescribing evaluation criteria developed by Adorka et al39. Profile of antibiotics used by mothers for their under-five children and reasons for use were explored, while relationship between mother's educational status and some specific response on antibiotics used was subsequently investigated.…”

Assessment of Antibiotic Utilization Pattern In Hospital Settings

“…The prolonged duration of antimicrobial therapy with or without evidence of infection, failure to select the suitable antimicrobial agent when the respective specimen culture and antimicrobial susceptibility data are available, selection of an antibiotic which is too broad or too narrow and prescribing sub therapeutic or an over dose leads to inappropriate use of antibiotics. So before choosing an antibiotic, the prescriber should send the specimen for identifying the microorganism before initiating an antimicrobial therapy whenever necessary (Adorka et al, 2014;Saleem et al, 2019). It is also vital to see to the appropriate selection of the antibiotics with respect to its spectrum of activity, physicochemical, phar-macokinetic, pharmacodynamic properties, antibiotic susceptibility pattern, clinical symptoms, and severity of the condition, co morbidities and other types of infection or disease conditions for prescribing an antibiotic.…”

Initiative to progress research on medicine utilization in Africa: formation of the Medicines Utilization Research in Africa group

“…Matthias Adorka discussed ongoing research in Namibia, which includes antibiotic prescribing practices in outpatient departments of public hospitals and affiliate clinics (10,11) as well as (i) assessment of current antibiotic prescribing in respiratory tract infections; (ii) the development of a computerized algorithm for the appropriate prescribing of antibiotics in the treatment of respiratory tract infections in primary healthcare settings and (iii) Therapeutic Drug Monitoring of anti-TB drugs in drug resistant patients. Other projects included assessing gentamicin therapy in the elderly and whether there is a need to carry out renal function tests before commencing therapy using a pharmacokinetic approach.…”

“…Initial disease areas for comparing utilisation and policies across countries include antibiotics and ARVs. This will start with southern Africa countries, building on previous research surrounding antibiotics (6,10,11,18,20). Other research topics include policies surrounding generics as well as complementary and alternative medicines.…”