Point-prevalence study of antimicrobial use in public hospitals in southern Sri Lanka identifies opportunities for improving prescribing practices

Sheng, Tianchen; Wijayaratne, Weerasinghe Mudiyanselage Dilip Gaya Bandara; Dabrera, Thushani; Drew, Richard; Nagahawatte, Ajith; Bodinayake, Champica K; Kurukulasooriya, Ruvini; Østbye, Truls; Nagaro, Kristin; Silva, Cherin De; Ranawakaarachchi, Hasini; Sudarshana, A T; Anderson, Deverick J.; Woods, Christopher W.; Tillekeratne, L. Gayani

doi:10.1017/ice.2018.321

Cited by 15 publications

(17 citation statements)

References 6 publications

(12 reference statements)

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“…Conversely, a majority of patients with respiratory illnesses received an antibiotic prescription. These findings parallel previous observations in the inpatient setting in Sri Lanka, where lower respiratory tract infections were the most common indication for antibiotic therapy among hospitalized patients, as well as data from high-income countries showing high rates of outpatient antibiotic prescription for acute respiratory conditions [ 7 , 10 , 15 ]. Interventions targeting prescribing practices for acute respiratory tract infections thus represent a high-yield opportunity for antimicrobial stewardship.…”

Section: Discussionsupporting

confidence: 89%

“…Decades of widespread antibiotic use have created selective pressure for the development of AMR, with increasing antibiotic consumption especially pronounced in LMICs [ 6 ]. A recent point-prevalence survey of antimicrobial use in Sri Lankan public hospitals revealed that more than one-half of all inpatients and nearly all patients in intensive care wards were receiving antimicrobials at the time of survey; approximately one-third of antimicrobials were deemed to be potentially inappropriate [ 7 ]. Systematic data on outpatient antimicrobial prescribing practices in Sri Lanka, however, remain limited.…”

Section: Introductionmentioning

confidence: 99%

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Point-prevalence survey of outpatient antibiotic prescription at a tertiary medical center in Sri Lanka: opportunities to improve prescribing practices for respiratory illnesses

et al. 2021

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Background Inappropriate antibiotic use is linked to the spread of antimicrobial resistance worldwide, but there are limited systemic data on antibiotic utilization in low- and middle-income countries. The purpose of this study was to evaluate the prevalence and patterns of antibiotic prescription in an ambulatory care setting in Sri Lanka. Methods This cross-sectional survey was conducted at the Outpatient Department of a public tertiary medical center in Southern Province, Sri Lanka from February to April 2019. Among consecutive outpatients presenting for care, questionnaires were verbally administered to a systematic random sample to capture information about patient demographics, illness characteristics, and visit outcomes. Prescription data were obtained from the outpatient pharmacy’s electronic prescribing system. Results Of 409 surveyed patients, 146 (35.7%) were prescribed an antibiotic. The most frequently prescribed agents were amoxicillin (41 patients, 28.1% of antibiotic recipients) and first-generation cephalosporins (38, 26.0%). Respiratory indications were the most common reason for antibiotic use, comprising 69 (47.3%) of all antibiotic prescriptions. Antibiotics were prescribed for 66.1% of patients presenting with cough and 78.8% of those presenting with rhinorrhea or nasal congestion. Among all antibiotic recipients, 6 (4.1%) underwent diagnostic studies. Conclusions A high prevalence of antibiotic prescription was observed, in particular for treatment of respiratory conditions. These data support the need for improved antimicrobial stewardship in the Sri Lankan outpatient setting.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Point-prevalence survey of outpatient antibiotic prescription at a tertiary medical center in Sri Lanka: opportunities to improve prescribing practices for respiratory illnesses

et al. 2021

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“…In our study 103(48.1%) patients were on antibiotics. In a study done in Northern Ireland 44.1% of patients were given antibiotics 9 and in a study done in Sri Lanka 54.7% of patients were given antibiotics 10 . These studies had overall rates of prescription of antibiotics at similar levels to our study.…”

Section: Discussionmentioning

confidence: 98%

“…Tianchen et al, in a study done in Sri Lanka, found that the most commonly prescribed antimicrobial was amoxicillin/clavulanic acid. However, treating the patients with β-lactam-β-lactam inhibitor combination is recommended for a few conditions, for example, community-acquired pneumonia 10 . Therefore, adherence to the national and international guidelines should be emphasized in this circumstance.…”

Section: Discussionmentioning

confidence: 99%

“…Because of the paucity of data in the BHTs, it is exceedingly difficult to find whether it was rational or not. A previous study, which was done in Sri Lanka in 2019 also found inappropriate use of antibiotics in the ward setting, where 31% of antibiotic prescriptions were irrational 10 . However, here when compared with our national guidelines 4 , among 71 patients who had indications for the treatment, 80.2% of antibiotics use complied with guidelines.…”

Section: Antibioticmentioning

confidence: 94%

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Point prevalence survey of antimicrobial prescriptions in selected units of National Hospital Kandy, Sri Lanka

Devakanthan¹,

Kothalawala²,

Galgamuwa³

et al. 2021

SL J. Med.

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Background: Lack of feedback to the prescribers might affect the core of the Antibiotic Stewardship Programme (ASP). Point prevalence surveys on antibiotic use and feedback will improve the rational use of antibiotics and prevent the emergence of multidrug-resistant bacteria. Objectives:We aim to describe the antibiotic use and compliance with standard antibiotic guidelines at selected units in National Hospital, Kandy (NHK).Methods: Data were collected from selected units at NHK. An interviewer-administered questionnaire was used to collect data. All patients who were in the ward at 9 am on the day of the survey were included in the study. Observations were analyzed to find out the rational use of antibiotics.Results: Among 214 patients, 103(48.1%) were on antibiotics. The highest usage was observed in surgical units. The most common antibiotic used was amoxicillin-clavulanate and sparing of carbapenems was observed. Even though 71(68.9%) bed head tickets (BHT) carried indications for antibiotic use; only one patient was on targeted treatment. Fifty-seven (80.2%) received antibiotics according to the National Antibiotic Guideline considering site of infection and 14(19.8%) did not comply with the guidelines. Conclusion:Compliance rate with guidelines and documentation has room for improvement through implementing ASP, availability of user-friendly guidelines and the periodic audit in the hospital.

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Epidemiology of multidrug-resistant Enterobacteriaceae in Sri Lanka: First evidence of bla harboring Klebsiella pneumoniae

Kumudunie

Wijesooriya

Namalie

et al. 2020

Journal of Infection and Public Health

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Point-prevalence study of antimicrobial use in public hospitals in southern Sri Lanka identifies opportunities for improving prescribing practices

Cited by 15 publications

References 6 publications

Point-prevalence survey of outpatient antibiotic prescription at a tertiary medical center in Sri Lanka: opportunities to improve prescribing practices for respiratory illnesses

Point-prevalence survey of outpatient antibiotic prescription at a tertiary medical center in Sri Lanka: opportunities to improve prescribing practices for respiratory illnesses

Point prevalence survey of antimicrobial prescriptions in selected units of National Hospital Kandy, Sri Lanka

Epidemiology of multidrug-resistant Enterobacteriaceae in Sri Lanka: First evidence of bla harboring Klebsiella pneumoniae

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