Emergency department antimicrobial use in a low-resource setting: results from a retrospective observational study at a referral hospital in Liberia

Abstract

ObjectiveData on antimicrobial use in low-income and middle-income countries (LMICs) remain limited. In Liberia, the absence of local data impedes surveillance and may lead to suboptimal treatment, injudicious use and resistance against antimicrobials. This study aims to examine antimicrobial prescribing patterns for patients in the emergency department (ED) of a large Liberian public hospital. Secondarily, this prescribing was compared with WHO prescribing indicators.DesignRetrospective observational study.SettingAn adult ED of a large public hospital in Monrovia, Liberia.ParticipantsA total of 1082 adult patients (>18 years of age) were recorded in the ED, from 1 January to 30 June 2019.Main outcome measuresNumber, type and name of antimicrobials ordered per patient were presented as number and percentages, with comparison to known WHO prescribing indicators. Pearson χ2 tests were used to assess patient variables and trends in medication use.ResultsOf the total patients, 44.0% (n=476) were female and the mean age was 40.2 years (SD=17.4). An average of 2.78 (SD=2.02) medicines were prescribed per patient encounter. At least one antimicrobial was ordered for 64.5% encounters (n=713) and two or more antimicrobials for 35.7% (n=386). All antimicrobial orders in our sample used the generic name. Ceftriaxone, metronidazole and ampicillin were the most common and accounted for 61.2% (n=743) of antimicrobial prescriptions. The majority (99.9%, n=1211) of antimicrobials prescribed were from the WHO Essential Drugs List.ConclusionThis study is one of the first on ED-specific antimicrobial use in LMICs. We revealed a high rate of antimicrobial prescription, regardless of patient demographic or diagnosis. While empiric antimicrobial use is justified in certain acute clinical scenarios, the high rate from this setting warrants further investigation. The results of this study underscore the importance of ED surveillance to develop targeted antimicrobial stewardship interventions and improve patient care.

The Challenges of The Diagnostic and Therapeutic Approach of Patients with Infectious Pathology in Emergency Medicine

“…Antibiotic administration is profoundly influenced by patient demographic variables as well as diagnosis. High prescription rate use of antimicrobial treatments, regardless of these variables, however, has been observed in ED low-resource settings, highlighting the importance of surveillance in order to implement targeted intervention [19,20]. Moreover, in countries with a high consumption of antibiotics in Europe (such as Romania), an increase in antibiotic consumption is observed in winter and spring, thus causing a selective pressure and subsequently, an increase in multidrug resistance in community bacterial strains after a time delay of several months.…”