Evaluation of Antimicrobial Utilization and Concordance with National Guidelines at a Tertiary Hospital in the Southern Highlands Zone of Tanzania

Abstract

Antimicrobial resistance is a growing concern in sub-Saharan Africa, and antimicrobial stewardship (AMS) programs have not been widely implemented in this region. We evaluated antibiotic prescribing patterns and concordance with national guidelines at Mbeya Zonal Referral Hospital (MZRH) in Tanzania. Adult inpatient medical records were chronologically reviewed from January 1, 2018 until 100 records documenting antibiotic therapy were evaluated. The primary endpoint was concordance with national guidelines for indication-based antibiotic selection and duration. Data were summarized using descriptive statistics. Overall, 155 records with sufficient data were reviewed. The 100 records which involved antibiotic therapy represented 171 unique antibiotic courses. The most common indication for antibiotics was bacterial pneumonia. Ceftriaxone and metronidazole, the most commonly used antibiotics, were administered in 40% and 24% of courses, respectively. Indication-based antibiotic selection was concordant with national guidelines in 63% of courses, but this fell to 15% when course duration was taken into account. Antibiotic courses were completed as prescribed 28% of the time among evaluable courses. A microbiologic culture of any kind was obtained in 17% of patients. In conclusion, antibiotic therapy was often incomplete, was generally guideline discordant, exhibited limited diversity of selection, and frequently lacked diagnostic confirmation. These data, combined with local susceptibility patterns, may be used to foster AMS efforts for improved compliance with guidelines at MZRH in the future.

Antimicrobial use across six referral hospitals in Tanzania: a point prevalence survey

“…22 The finding of high adherence in Mbeya ZRH (94.0%), in contrast to the 63.0% found in 2018 by another study in the same hospital, may be accounted for by the possibility of postsurvey sensitisation and/or awareness. 28 This is further exemplified by the low proportion of antibiotic use in this hospital, which is in contrast to all other hospitals. The findings of moderate adherence to the Standard Treatment Guidelines in Sekou Toure RRH and Maweni RRH call for in-depth analysis on the underlying causes and provision of specific remedial measures.…”

Adherence to standard treatment guidelines among prescribers in primary healthcare facilities in the Dodoma region of Tanzania

“…AMS programmes that have positively affected the behaviour of clinicians’ antibiotic utilization and proven to be effective in high-income countries have also been introduced to African countries with some success [ 16 , 25 – 27 ]. One such programme was initiated in Mbeya Zonal Referral Hospital of Tanzania [ 28 , 29 ]. A baseline assessment of antibiotic prescription in this training hospital revealed that prescribers adhered to the Tanzania STG recommendations for antibiotic choice 63% of the time, but it decreased to 15% when treatment duration was taken into account.…”

The Mbeya Antimicrobial Stewardship Team: Implementing Antimicrobial Stewardship at a Zonal-Level Hospital in Southern Tanzania

“…It was perhaps surprising, however, to note how empirical treatment infrequently fully aligned with national guidelines. While nearly two-thirds of patients were initiated on the recommended agents, only 15% were able to complete the required therapy [31]. Empirical recommendations and durations are of paramount importance, because in our chart review of inpatient prescribing, only 15% of patients had diagnostic testing.…”

“…Two-thirds of prescribed antimicrobial courses in the hospital setting were not completed for various reasons. Full results are published elsewhere [31].…”