Surgical prophylaxis in Haydom Lutheran Hospital, Tanzania - learning from a point prevalence survey

Antimicrobial resistance (AMR) is a significant global health concern, with improper antibiotic use contributing to its rise. Tanzania initiated an AMR action plan in 2017, but comprehensive surveillance and stewardship efforts remain limited. This study focused on evaluating antibiotic use, particularly surgical prophylaxis, in a rural Tanzanian hospital.

The study was conducted at Haydom Lutheran Hospital in Tanzania in May 2023, using a cross-sectional point prevalence survey. Antibiotic use in all patients admitted for >24 h and those undergoing surgery was recorded, including type, dose, indication and duration. Quality indicators for surgical prophylaxis were assessed.

Among 199 inpatients, 55% received antibiotics, with surgical prophylaxis accounting for 23% of prescriptions. Notably, none of the patients who received surgical prophylaxis received a single-dose regimen, and 67% exceeded the recommended 24-h duration. A combination of ampicillin-cloxacillin plus metronidazole was the most commonly prescribed combination for surgical prophylaxis (41% of prescriptions). Thirty-three percent of the antibiotics prescribed for surgical prophylaxis were classified as 'Not recommended' by the World Health Organization. Furthermore, 90% of surgical prophylaxis prescriptions lacked documented rationale, and 83% of prescriptions lacked stop/review dates in medical records.

This study reveals a high prevalence of prolonged antibiotic use for surgical prophylaxis, frequent use of antibiotics classified as 'Not recommended', and a lack of adequate documentation, which deviates from international standards. These practices highlight the urgent need for contextualized national guidelines, large-scale implementation projects of evidence-based interventions, and local initiatives in antibiotic stewardship, particularly in low-resource settings.