Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future

Abstract

There are serious concerns with rising antimicrobial resistance (AMR) across countries increasing morbidity, mortality and costs. These concerns have resulted in a plethora of initiatives globally and nationally including national action plans (NAPs) to reduce AMR. Africa is no exception, especially with the highest rates of AMR globally. Key activities in NAPs include gaining a greater understanding of current antimicrobial utilization patterns through point prevalence surveys (PPS) and subsequently instigating antimicrobial stewardship programs (ASPs). Consequently, there is a need to comprehensively document current utilization patterns among hospitals across Africa coupled with ASP studies. In total, 33 PPS studies ranging from single up to 18 hospitals were documented from a narrative review with typically over 50% of in-patients prescribed antimicrobials, up to 97.6% in Nigeria. The penicillins, ceftriaxone and metronidazole, were the most prescribed antibiotics. Appreciable extended prescribing of antibiotics up to 6 days or more post-operatively was seen across Africa to prevent surgical site infections. At least 19 ASPs have been instigated across Africa in recent years to improve future prescribing utilizing a range of prescribing indicators. The various findings resulted in a range of suggested activities that key stakeholders, including governments and healthcare professionals, should undertake in the short, medium and long term to improve future antimicrobial prescribing and reduce AMR across Africa.

Understanding of Final Year Medical, Pharmacy and Nursing Students in Pakistan towards Antibiotic Use, Antimicrobial Resistance and Stewardship: Findings and Implications

“…We are aware that studies have been published with different student cohorts across LMICs including Pakistan; however, we are unaware of any studies that have combined all three key student populations among both public and private universities in LMICs [69,70,[72][73][74][75][76][77][78][79][80][81][82][83]. This is increasingly important, with multidisciplinary teams being key to improving future antibiotic prescribing as part of ASPs [27].…”

“…We are aware that there have been concerns that it is difficult to fully instigate ASPs in LMICs due to resource and available personnel issues, as well as a lack of knowledge [41,107]. However, this is changing, as seen, for instance, in Africa, as well as other LMICs [22,27,[108][109][110].…”

“…This leads to inappropriate medicine use, including antimicrobials, resulting in the need to rapidly implement agreed NAPs [12,13,17]. There are also concerns regarding the inappropriate prescribing of antimicrobials in hospitals, further exacerbated by the COVID-19 pandemic, despite few bacterial or fungal co-infections (3.5-14.3% of patients) [20,[27][28][29][30][31].…”

Current Antibiotic Use Among Hospitals in the sub-Saharan Africa Region; Findings and Implications

“…The included studies will be obtained from previous reviews by the authors to supplement efforts to improve antibiotic utilization in sub-Saharan Africa. 7 , 9 , 13 , 20 As such, include the findings from PPS studies undertaken among a range of African countries. PPS studies document the extent of antimicrobial prescribing among all in-patients in hospital on the morning of the survey, eg, 0800.…”

“… 4 , 7 , 9 In a recent review by the authors, quality indicators being used to improve antibiotic prescribing were reviewed. 20 These will be summarized alongside their inclusion in the sourced papers to provide future guidance. The development of prescribing or quality indicators enables antimicrobial stewardship teams within hospitals to determine which activities and areas to prioritize as part of ASPs along the prescribing pathway and assess their progress to improve future prescribing.…”