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Published on: August 30, 2018
Antibiotic Use and Stewardship Indicators in the First- and Second-Level Hospitals in Zambia: Findings and
Aubrey C Kalungia1, Moses Mukosha1, Chiluba Mwila1
1Department of Pharmacy, University of Zambia, Lusaka P.O. Box 50110, Zambia.
Insights
Antimicrobial resistance is a growing concern in Zambia. A survey found high antibiotic use, particularly ceftriaxone, with poor documentation and low guideline compliance, necessitating antimicrobial stewardship programs (ASPs).
Area of Science:
- Global Health
- Infectious Diseases
- Pharmacology
Background:
- Rising antimicrobial resistance (AMR) in Africa, including Zambia, is linked to inappropriate antibiotic use.
- Hospitals need to document prescribing patterns to inform antimicrobial stewardship programs (ASPs).
Purpose of the Study:
- To assess antibiotic prescribing patterns in Zambian hospitals using a point prevalence survey (PPS).
- To identify areas for improvement in antibiotic utilization and inform the development of ASPs.
Main Methods:
- A World Health Organization (WHO) methodology PPS was conducted in 10 public hospitals across Zambia.
- In-patient antibiotic use, prescribing rationale, and compliance with national standard treatment guidelines (STGs) were assessed.
Main Results:
- Antibiotic use prevalence was 59.0% (307/520) among in-patients.
- Ceftriaxone was frequently prescribed empirically (36.1%).
- Documentation of antibiotic use rationale (15.7%) and compliance with STGs (27.0%) were low.
Conclusions:
- High rates of empiric prescribing, limited documentation, and poor guideline adherence highlight the urgent need for ASPs in Zambia.
- Implementing ASPs can improve antibiotic prescribing quality and combat AMR.
Abstract:
Introduction: There are increasing concerns with growing rates of antimicrobial resistance (AMR) across Africa, including in Zambia, enhanced by inappropriate utilization of antibiotics across the sectors. There is a need in hospitals to document current prescribing patterns via point prevalence surveys (PPS) alongside recognized indicators to improve future use. The findings can subsequently be used to develop and instigate appropriate antimicrobial stewardship programs (ASPs) to improve the quality of future antimicrobial prescribing across Zambia. This includes encouraging the prescribing of 'Access' over 'Watch' and 'Reserve' antibiotics where pertinent. Methods: A PPS was undertaken using the WHO methodology among 10 first- and second-level public hospitals across the 10 provinces of Zambia. A sampling process was used to select the hospitals. Results: The prevalence of antibiotic use among the in-patients was 307/520 (59.0%), with a high rate of empiric prescribing of ceftriaxone at 36.1% of all antibiotics prescribed (193/534). The reason for antibiotic use was recorded in only 15.7% of occasions and directed treatment prescribed in only 3.0% of occasions. Compliance with the national standard treatment guidelines (STGs) was also low at only 27.0% of occasions. Conclusion: High empiric prescribing, limited documentation of the rationale behind antibiotic prescribing, high use of 'Watch' antibiotics, and limited compliance to STGs among surveyed hospitals requires the urgent instigation of ASPs across Zambia to improve future prescribing.
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