Prescription of Levofloxacin and Moxifloxacin in Select Hospitals in Uganda: A Pilot Study to Assess Guideline Concordance

Nambasa, Victoria; Ndagije, Helen Byomire; Serwanga, Allan; Manirakiza, Leonard; Atuhaire, Joanitah; Nakitto, Diana; Kiguba, Ronald; Figueras, Albert

doi:10.3390/antibiotics9080439

Cited by 9 publications

(7 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The findings obtained through our contextualised AMS checklist mirror the published AMS reports in LMICs, which highlight the presence of national antimicrobial prescribing guidelines in the countries where the sites are located [ 21 , 31 , 32 , 33 ] but identify the challenges in AMR-specific education and training, diagnostic facilities, regulation of safety and efficacy of medications, and shortages of healthcare personnel and expertise [ 34 , 35 , 36 , 37 ]. Although these studies highlight the overall gaps in AMS implementation in LMICs, the differences observed across the regions, hospitals, and sites also demonstrate the need for case-by-case evaluations of AMS programmes for the development of appropriate and sustainable solutions.…”

Section: Discussionsupporting

confidence: 60%

Development and Implementation of an Antimicrobial Stewardship Checklist in Sub-Saharan Africa: A Co-Creation Consensus Approach

Ashiru‐Oredope¹,

Garraghan

Olaoye³

et al. 2022

Healthcare

View full text Add to dashboard Cite

Antimicrobial stewardship (AMS) initiatives promote the responsible use of antimicrobials in healthcare settings as a key measure to curb the global threat of antimicrobial resistance (AMR). Defining the core elements of AMS is essential for developing and evaluating comprehensive AMS programmes. This project used co-creation and Delphi consensus procedures to adapt and extend the existing published international AMS checklist. The overall objective was to arrive at a contextualised checklist of core AMS elements and key behaviours for use within healthcare settings in Sub-Saharan Africa, as well as to implement the checklist in health institutions in four African countries. The AMS checklist tool was developed using a modified Delphi approach to achieve local expert consensus on the items to be included on the checklist. Fourteen healthcare/public health professionals from Tanzania, Zambia, Uganda, Ghana and the UK were invited to review, score and comment on items from a published global AMS checklist. Following their feedback, 8 items were rephrased, and 25 new items were added to the checklist. The final AMS checklist tool was deployed across 19 healthcare sites and used to assess AMS programmes before and after an AMS intervention in 14 of the 19 sites. The final tool comprised 54 items. Across the 14 sites, the completed checklists consistently showed improvements for all the AMS components following the intervention. The greatest improvements observed were the presence of formal multidisciplinary AMS structures (79%) and the execution of a point-prevalence survey (72%). The elements with the least improvement were access to laboratory/imaging services (7%) and the presence of adequate financial support for AMS (14%). In addition to capturing the quantitative and qualitative changes associated with the AMS intervention, project evaluation suggested that administering the AMS checklist made unique contributions to ongoing AMS activities. Furthermore, 29 additional AMS activities were reported as a direct result of the prompting checklist questions. Contextualised, co-created AMS tools are necessary for managing antimicrobial use across healthcare settings and increasing local AMS ownership and commitment. This study led to the development of a new AMS checklist, which proved successful in capturing AMS improvements in Tanzania, Zambia, Uganda, and Ghana. The tool also made unique contributions to furthering local AMS efforts. This study extends the existing AMS materials for low- and middle-income countries and provides empirical evidence for successful use in practice.

show abstract

Section: Discussionsupporting

confidence: 60%

Development and Implementation of an Antimicrobial Stewardship Checklist in Sub-Saharan Africa: A Co-Creation Consensus Approach

Ashiru‐Oredope¹,

Garraghan

Olaoye³

et al. 2022

Healthcare

View full text Add to dashboard Cite

show abstract

“…The ndings obtained through our contextualised AMS checklist mirror published AMS reports in LMICs, which highlight the presence of national antimicrobial prescribing guidelines in the countries where the sites are located [21][22][23][24] but identify challenges in AMR-speci c education and training, diagnostic facilities, regulation of safety and e cacy of medications and shortages of healthcare personnel and expertise [25][26][27][28]. Although these studies highlight overall gaps in AMS implementation in LMICs, the differences observed across regions, hospitals and sites also demonstrate the need for case-by-case evaluations of AMS programmes for the development of appropriate and sustainable solutions.…”

Section: Ams Checklist Implementationsupporting

confidence: 61%

Development and Implementation of an Antimicrobial Stewardship Checklist in Sub-saharan Africa: a Co-creation Consensus Approach

Ashiru‐Oredope¹,

Garraghan²,

Olaoye³

et al. 2022

Preprint

View full text Add to dashboard Cite

Background: Antimicrobial stewardship (AMS) initiatives promote the responsible use of antimicrobials in healthcare settings as a key measure to curb the global threat of antimicrobial resistance (AMR). Defining the core elements of AMS is essential for developing and evaluating comprehensive AMS programmes. This project used co-creation and Delphi-consensus procedures to adapt and extend the existing published international AMS checklist. The overall objective was to arrive at a contextualised checklist of core AMS elements and key behaviours for use within healthcare settings in Sub-Saharan Africa as well as to implement the checklist in health institutions in four African countries.Method:The AMS checklist tool was developed using a modified Delphi approach to achieve local, expert consensus on items to be included on the checklist. Fourteen healthcare/public health professionals from Tanzania, Zambia, Uganda, and Ghana were invited to review, score and comment on items from a published, global AMS checklist. Following their feedback, eight items were re-phrased and 25 new items added to the checklist. The final AMS checklist tool was deployed across 19 healthcare sites and used to assess AMS programmes before and after an AMS intervention in 14 of the 19 sites.Findings: The final tool comprised 54 items. Across the 14 sites, the checklist consistently showed improvements for all AMS components following the intervention. The greatest improvements observed were the presence of formal multidisciplinary AMS structures (79%) and the execution of a point-prevalence survey (72%). Elements with the least improvement were access to laboratory/imaging services (7%) and the presence of adequate financial support for AMS (14%). In addition to capturing quantitative and qualitative changes associated with the AMS intervention, project evaluation suggested that administering the AMS checklist made unique contributions to ongoing AMS activities. Furthermore, 29 additional AMS activities were reported as a direct result of the prompting checklist questions.Conclusion: Contextualised, co-created AMS tools are necessary for managing antimicrobial use across healthcare settings and increasing local AMS ownership and commitment. This study led to the development of a new AMS checklist which proved successful in capturing AMS improvements in Tanzania, Zambia, Uganda, and Ghana. The tool also made unique contributions to furthering local AMS efforts. The study extends existing AMS materials for low and middle-income countries and provides empirical evidence for successful use in practice.

show abstract

“…Many factors could contribute to the low adherence to the Uganda Clinical Guidelines, including poor dissemination of the guidelines, lack of proper diagnostic stewardship in hospitals, such as in microbiology and radiology, and long turnaround times for laboratory results. Lastly, in many settings, prescriber preferences and behaviors are a major cause for non-adherence to the guidelines [ 49 ]. Similar factors have been described elsewhere as barriers to guideline adherence [ 50 , 51 ].…”

Section: Discussionmentioning

confidence: 99%

Point Prevalence Survey of Antibiotic Use across 13 Hospitals in Uganda

Kiggundu¹,

Wittenauer

Waswa³

et al. 2022

Antibiotics

View full text Add to dashboard Cite

Standardized monitoring of antibiotic use underpins the effective implementation of antimicrobial stewardship interventions in combatting antimicrobial resistance (AMR). To date, few studies have assessed antibiotic use in hospitals in Uganda to identify gaps that require intervention. This study applied the World Health Organization’s standardized point prevalence survey methodology to assess antibiotic use in 13 public and private not-for-profit hospitals across the country. Data for 1077 patients and 1387 prescriptions were collected between December 2020 and April 2021 and analyzed to understand the characteristics of antibiotic use and the prevalence of the types of antibiotics to assess compliance with Uganda Clinical Guidelines; and classify antibiotics according to the WHO Access, Watch, and Reserve classification. This study found that 74% of patients were on one or more antibiotics. Compliance with Uganda Clinical Guidelines was low (30%); Watch-classified antibiotics were used to a high degree (44% of prescriptions), mainly driven by the wide use of ceftriaxone, which was the most frequently used antibiotic (37% of prescriptions). The results of this study identify key areas for the improvement of antimicrobial stewardship in Uganda and are important benchmarks for future evaluations.

show abstract

Prescription of Levofloxacin and Moxifloxacin in Select Hospitals in Uganda: A Pilot Study to Assess Guideline Concordance

Cited by 9 publications

References 20 publications

Development and Implementation of an Antimicrobial Stewardship Checklist in Sub-Saharan Africa: A Co-Creation Consensus Approach

Development and Implementation of an Antimicrobial Stewardship Checklist in Sub-Saharan Africa: A Co-Creation Consensus Approach

Development and Implementation of an Antimicrobial Stewardship Checklist in Sub-saharan Africa: a Co-creation Consensus Approach

Point Prevalence Survey of Antibiotic Use across 13 Hospitals in Uganda

Contact Info

Product

Resources

About