Antibiotic prescribing in public primary healthcare centres in Maseru, Lesotho

Inappropriate prescribing of antibiotics is a global problem. We assessed the prescribing patterns of antibiotics in three public primary healthcare centres (PHCCs) in Maseru, Lesotho.

A cross-sectional point prevalence survey was employed using patients' prescription booklets from October 2022 to December 2022.

Antibiotics were categorised according to the World Health Organization (WHO) AWaRe classification and assessed by Defined Daily Dose (DDD)/100 outpatients/day to measure relative consumption of each antibiotic as a percentage of total consumption, Access-to-Watch index (AW-I) and Amoxicillin Index (A-I).

Of the 624 participants (median age 35 [interquartile range {IQR}: 45-26] years), 71.5% (n = 446) were female. Overall mean (standard deviation [s.d.]) antibiotic consumption was 1.48 (0.13) DDD/100 outpatients/day, with PHCC-1 at 1.64, PHCC-2 at 1.33 and PHCC-3 at 1.47 DDD/100 outpatients/day. The median (IQR) AW-I was 4.64 (3.42-9.45) and the A-I was 1.41 (0.87-1.95). The most frequently prescribed Access group antibiotics included amoxicillin (PHCC-2: 45.9%, overall 1.33 DDD/100 outpatients/day; PHCC-3: 24.5%, 1.47 DDD/100 outpatients/day, and PHCC-1: 23.2%, 1.64 DDD/100 outpatients/day) and doxycycline (PHCC-3: 29.9%, 1.47 DDD/100 outpatients/day, 24.1%, PHCC-2: 1.33 DDD/100 outpatients/day). Erythromycin was the most prescribed Watch group antibiotic for all PHCCs.

High consumption of Access-group antibiotics was observed. The Watch group's antibiotic use, particularly erythromycin, requires the implementation of stewardship programmes. Results may be a baseline for establishing antibiotic stewardship in Lesotho's PHCCs.

Our study addressed the scarcity of data on antibiotic prescribing patterns in PHCCs in Lesotho using the AWaRe classification system recommended for monitoring antibiotic prescribing and promoting rational use.