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Published on: August 30, 2018
Hospital-Level Antibacterial Prescribing and Its Completeness in Ethiopia: Did It Adhere to Good Prescribing
Mekonnen Sisay1, Tigist Gashaw1, Firehiwot Amare2
1Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
Background:
Antibacterial agents are an integral part of chemotherapy and play a critical role in the prophylaxis and treatment of bacterial infections. However, prescribing errors such as incomplete prescriptions that do not adhere to good prescribing practice have become a contemporary concern in hospitals in resource-limited settings. Therefore, this study aimed to assess antibacterial prescribing and its completeness among prescriptions dispensed at four governmental hospitals in Eastern Ethiopia.
Methods:
A cross-sectional study was employed to assess a total of 1308 prescription encounters containing at least one antibacterial agent obtained with simple random sampling from annual antibacterial-containing prescription data of four hospitals. The data were collected retrospectively using a structured checklist.
Results:
A total of 2,855 drugs were prescribed from 1308 prescribing encounters with 1496 (52.39%) being antibacterial agents. The name, age, sex, and diagnosis of the patients were written in 1158 (88.3%), 815 (62.31%), 796 (60.58%), and 183 (13.99%) prescriptions, respectively. Besides, the route of administration, strength, duration, quantity, dose, and dosage form of the drug were recorded in 2322 (81.33%), 2118 (74.19%), 1516 (53.10%), 1525 (53.42%), 746 (26.13%) and 563 (19.72%) prescriptions, respectively. Nearly 50% of the prescribing encounters were documented without a prescriber name. Dispenser name and signature were also obtained in less than 10% of the prescriptions. Combining the data of all hospitals, amoxicillin, ceftriaxone, and ciprofloxacin were identified as the top three prescribed antibacterial drugs, whereas diclofenac, paracetamol, and tramadol were the most frequently co-indicated drugs. Regarding the pharmacologic class of antibiotics, penicillins were the most commonly prescribed antibiotics (n = 596, 39.77%) followed by cephalosporins (n = 318, 21.26%) and fluoroquinolones (n=285, 19.05%).
Conclusion:
Incomplete information about patient-related factors and major diagnosis, medication regimens, prescribers and dispensers was identified as a potential prescribing error and did not adhere to good prescribing practice. This can be considered as one part of the inappropriate use of antibacterial agents, a driving force for the emergence of antimicrobial resistance. This problem requires immediate and sustained action from the management of the hospitals to ensure the accountability of health professionals involved in the medication use process and to establish antimicrobial stewardship programs in such resource-limited settings.
Insights
Prescribing errors, including incomplete patient information and medication details, were common in Ethiopian hospitals. This highlights a need for improved prescribing practices to combat antimicrobial resistance.
Area of Science:
- Pharmacology
- Public Health
- Health Services Research
Background:
- Antibacterial agents are crucial in chemotherapy and infection management.
- Prescribing errors, particularly incomplete prescriptions, are a growing concern in resource-limited healthcare settings.
- This study addresses the need to evaluate antibacterial prescribing practices in Eastern Ethiopian public hospitals.
Purpose of the Study:
- To assess the completeness of antibacterial prescriptions dispensed in four governmental hospitals in Eastern Ethiopia.
- To identify common prescribing errors related to patient information, medication details, and prescriber/dispenser accountability.
- To provide data for improving prescribing practices and antimicrobial stewardship.
Main Methods:
- A cross-sectional study design was utilized.
- Data were retrospectively collected from 1308 prescription encounters containing antibacterial agents using a structured checklist.
- Simple random sampling was applied to select prescriptions from annual data.
Main Results:
- Antibacterial agents constituted 52.39% of the 2,855 prescribed drugs.
- Key patient information (name, age, sex, diagnosis) and medication details (route, strength, duration, dose) were frequently missing.
- Prescriber and dispenser information was recorded in less than 50% and 10% of prescriptions, respectively. Amoxicillin, ceftriaxone, and ciprofloxacin were the most prescribed antibacterials.
Conclusions:
- Significant gaps in prescription completeness indicate potential prescribing errors and non-adherence to good prescribing practices.
- Incomplete prescribing contributes to the inappropriate use of antibacterial agents, driving antimicrobial resistance.
- Immediate interventions are needed, including enhanced accountability and antimicrobial stewardship programs in resource-limited settings.
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