Point prevalence survey of antimicrobial prescription in a tertiary hospital in South East Nigeria: A call for improved antibiotic stewardship

Umeokonkwo, Chukwuma David; Madubueze, Ugochukwu C.; Onah, Cosmas Kenan; Okedo‐Alex, Ijeoma Nkem; Adeke, Azuka Stephen; Versporten, Ann; Goossens, Herman; Igwe-Okomiso, Dorothy; Okeke, Kingsley Chijioke; Azuogu, Benedict Ndubueze; Onoh, Robinson Chukwudi

doi:10.1016/j.jgar.2019.01.013

Cited by 46 publications

(78 citation statements)

References 24 publications

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“…The current study found that review of initial antibiotic prescription was common as demonstrated by the change of about 40% of all the prescriptions. This confirmed the result of a previous study in Nigeria [10]. In the current study, switch to oral antibiotic and deescalation were reported in about one-third of the prescriptions indicating frequent review of prescription based on clinical and microbiological parameters.…”

Section: Discussionsupporting

confidence: 92%

“…Overall, nitroimidazoles, third generation cephalosporins and fluoroquinolones were the most commonly prescribed antibiotic groups. This was similar to previous findings in Southern Nigeria [10,11]. In addition, metronidazole, ciprofloxacin, ceftriaxone, and amoxicillin clavulanate were the most used antibiotics among the surveyed patients.…”

Section: Discussionsupporting

confidence: 90%

“…The study found that four in every five hospitalized patients received at least one antibiotic each day and approximately two-third of the antibiotics were used for treatment of community acquired infections and surgical prophylaxis. The prevalence of antibiotic use in the current study was consistent with a similar study conducted in South East Nigeria (78.6%) [10]. The prevalence of antibiotic use among hospitalized patients in Nigeria was higher than other African countries including Ghana (51.4%) [16] and Benin (64.6%) [8], Europe (30.5%) [6], and the United States (49.9%) [7].…”

Section: Discussionsupporting

confidence: 89%

“…In addition, metronidazole, ciprofloxacin, ceftriaxone, and amoxicillin clavulanate were the most used antibiotics among the surveyed patients. Again, this was consistent with the studies conducted in the southern parts of Nigeria [10,11], but was inconsistent with the results in neighboring African countries including Ghana and Benin [8,16]. These inconsistencies could be explained by differences in antimicrobial resistance patterns and empirical antimicrobial treatment recommendations between the countries.…”

Section: Discussionsupporting

confidence: 64%

“…In Nigeria, studies showed that the prevalence of antibiotic use among hospitalized patients ranged from 62.4 to 78.2% [9][10][11]. Community acquired infection was the most common indication and third generation cephalosporin and nitro-imidazole were the most commonly prescribed antibiotics [9][10][11], however, most of the studies were conducted in a single tertiary healthcare center in the southern part of Nigeria. There is limited data describing the rate and indications for the use of antibiotics among hospitalized patients in Northern Nigeria.…”

Section: Introductionmentioning

confidence: 99%

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Antibiotic use among hospitalized patients in northern Nigeria: a multicenter point-prevalence survey

Abubakar

2020

BMC Infect Dis

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Background: The evaluation of antibiotic use among hospitalized patients is a primary step required to design antibiotic stewardship intervention. There is paucity of data describing antibiotic use in hospitals across Northern Nigeria. This study evaluates the prevalence and indications for antibiotic use among inpatients in three acute care hospitals. Methods: A point-prevalence survey was conducted among patients in the wards before or at 8.00 a.m. on the day of the survey, using the point-prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals protocol. The survey was conducted between April and May 2019. The medical records of the patients were reviewed by a clinical pharmacist with the support of physicians and nurses.Results: Overall, 80.1% (257/321) of the patients used at least one antibiotic on the day of the survey. The prevalence of antibiotic use ranged from 72.9% in obstetrics and gynecology to 94.6% in pediatric medical specialty. Community acquired infections (38.7%) and surgical antibiotic prophylaxis (22.5%) were the most common indications. Surgical antibiotic prophylaxis was used or scheduled to be used for more than a day in all the cases. Metronidazole (30.5%), ciprofloxacin (17.1%), ceftriaxone (16.8%), amoxicillin-clavulanate (12.5%) and gentamicin (11.8%) were the most commonly prescribed antibiotics. Overall, broad spectrum antibiotics represented one-third of all the prescriptions. The change of initial antibiotic prescription was reported in one-third of the patients and the reasons include a switch to oral antibiotic (28.5%), escalation (4.5%) and de-escalation (3.6%). Of the 257 patients with an antibiotic prescription, 6.2% had redundant antibiotic combinations. Conclusion:The prevalence of antibiotic use was high with one in three prescriptions having a broad spectrum antibiotic. Prolonged use of surgical antibiotic prophylaxis and redundant antibiotic combination were observed. Antimicrobial stewardship interventions are recommended in order to reduce the use of antibiotics and promote appropriate antibiotics prescribing.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 64%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Antibiotic use among hospitalized patients in northern Nigeria: a multicenter point-prevalence survey

Abubakar

2020

BMC Infect Dis

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QuEChERS Approach for the Analysis of Three Fluoroquinolone Antibiotics in Wastewater: Concentration Profiles and Ecological Risk in Two Nigerian Hospital Wastewater Treatment Plants

Ajibola

Amoniyan

Ekoja

et al. 2020

Arch Environ Contam Toxicol

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Antibiotic Use Among Hospitalized Patients in Africa: A Systematic Review of Point Prevalence Studies

Abubakar

Salman

2023

J. Racial and Ethnic Health Disparities

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Background There is paucity of data describing the rate and quality indices of antibiotics used among hospitalized patients at continental level in Africa. This systematic review evaluated the pooled prevalence, indications, and types of antibiotics used in hospitals across Africa. Methods Three electronic databases, PubMed, Scopus, and African Journals Online (AJOL), were searched using search terms. Point prevalence studies of antibiotic use in inpatient settings published in English language from January 2010 to November 2022 were considered for selection. Additional articles were identified by checking the reference list of selected articles. Results Of the 7254 articles identified from the databases, 28 eligible articles involving 28 studies were selected. Most of the studies were from Nigeria (n = 9), Ghana (n = 6), and Kenya (n = 4). Overall, the prevalence of antibiotic use among hospitalized patients ranged from 27.6 to 83.5% with higher prevalence in West Africa (51.4–83.5%) and North Africa (79.1%) compared to East Africa (27.6–73.7%) and South Africa (33.6–49.7%). The ICU (64.4–100%; n = 9 studies) and the pediatric medical ward (10.6–94.6%; n = 13 studies) had the highest prevalence of antibiotic use. Community-acquired infections (27.7–61.0%; n = 19 studies) and surgical antibiotic prophylaxis (SAP) (14.6–45.3%; n = 17 studies) were the most common indications for antibiotic use. The duration of SAP was more than 1 day in 66.7 to 100% of the cases. The most commonly prescribed antibiotics included ceftriaxone (7.4–51.7%; n = 14 studies), metronidazole (14.6–44.8%; n = 12 studies), gentamicin (n = 8 studies; range: 6.6–22.3%), and ampicillin (n = 6 studies; range: 6.0–29.2%). The access, watch, and reserved group of antibiotics accounted for 46.3–97.9%, 1.8–53.5%, and 0.0–5.0% of antibiotic prescriptions, respectively. The documentation of the reason for antibiotic prescription and date for stop/review ranged from 37.3 to 100% and 19.6 to 100%, respectively. Conclusion The point prevalence of antibiotic use among hospitalized patients in Africa is relatively high and varied between the regions in the continent. The prevalence was higher in the ICU and pediatric medical ward compared to the other wards. Antibiotics were most commonly prescribed for community-acquired infections and for SAP with ceftriaxone, metronidazole, and gentamicin being the most common antibiotics prescribed. Antibiotic stewardship is recommended to address excessive use of SAP and to reduce high rate of antibiotic prescribing in the ICU and pediatric ward.

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Point prevalence survey of antimicrobial prescription in a tertiary hospital in South East Nigeria: A call for improved antibiotic stewardship

Cited by 46 publications

References 24 publications

Antibiotic use among hospitalized patients in northern Nigeria: a multicenter point-prevalence survey

Antibiotic use among hospitalized patients in northern Nigeria: a multicenter point-prevalence survey

QuEChERS Approach for the Analysis of Three Fluoroquinolone Antibiotics in Wastewater: Concentration Profiles and Ecological Risk in Two Nigerian Hospital Wastewater Treatment Plants

Antibiotic Use Among Hospitalized Patients in Africa: A Systematic Review of Point Prevalence Studies

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