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Published on: August 30, 2018
Prevalence and patterns of antibiotic prescriptions in Conakry hospitals, Guinea: a multicentre cross-sectional
Thibaut Armel Chérif Gnimadi1,2, Kadio Jean-Jacques Olivier Kadio1,3, Aïssata Camara3,4
1Centre de Recherche et de Formation en Infectiologie de Guinée (CERFIG), Université Gamal Abdel Nasser de Conakry, Conakry, Guinea.
Background:
Inappropriate use of antibiotics is a major driver of antimicrobial resistance (AMR), particularly in low- and middle-income countries. Understanding antibiotic use and patterns in hospital settings is essential for promoting rational use and optimizing antimicrobial stewardship (AMS). This study aims to assess the extent of antibiotic prescribing in secondary and tertiary hospitals in Conakry, Guinea, and to evaluate the appropriateness of these prescriptions on the basis of WHO recommendations via the Access, Watch, Reserve (AWaRe) classification of antibiotics.
Methods:
A multicentre cross-sectional survey was conducted from June to October 2024 to assess patient antibiotic use levels across six hospital wards in Conakry, capital of Guinea. The prevalence of antibiotic prescriptions, with 95% confidence intervals (CI), was compared across patient, prescriber and ward variables. Antibiotic use was categorized by Anatomic Therapeutic Chemical and AWaRe classifications. Associations between categorical variables were assessed using the Chi-square or Fisher's exact test. Univariate and multivariate logistic regression were used to analyse factors associated with antibiotic prescription.
Results:
Of 1482 patients surveyed, the overall prevalence of antibiotic prescriptions was 35.0% (95% CI: 32.6-37.5), with significant differences between inpatients (83.4%, 95% CI: 78.1-87.6) and outpatients (25.1%, 95% CI: 22.7-27.6). The total number of antibiotics prescribed was 669, and the most commonly prescribed antibiotics were beta-lactams/beta-lactamase inhibitors (24.2%), followed by third-generation cephalosporins (21.7%), imidazoles (18.5%), and penicillins (13.6%). Almost all antibiotic courses (99.4%) were started empirically, without microbiological testing to guide choice. Regarding the AWaRe classification of all prescribed antibiotics, Access antibiotics accounted for 64.3% (430/669), and 33.3% (223/669) were from the Watch group.
Conclusions:
The results of this study, conducted in six hospital departments, provide an overview of antibiotic prescriptions in Conakry hospitals, with a high prevalence of antibiotic prescription, particularly among inpatients and almost all courses were initiated empirically without microbiological guidance. These findings underscore the urgent need for AMS programs and interventions.
Insights
High antibiotic prescribing rates were found in Conakry hospitals, especially for inpatients, with most treatments initiated empirically. This highlights an urgent need for antimicrobial stewardship programs to combat antimicrobial resistance.
Area of Science:
- Global Health
- Infectious Diseases
- Pharmacology
Background:
- Inappropriate antibiotic use drives antimicrobial resistance (AMR), particularly in low- and middle-income countries.
- Understanding hospital antibiotic use is crucial for rational prescribing and antimicrobial stewardship (AMS).
Purpose of the Study:
- To assess antibiotic prescribing prevalence and appropriateness in secondary and tertiary hospitals in Conakry, Guinea.
- To evaluate prescriptions against WHO's Access, Watch, Reserve (AWaRe) antibiotic classification.
Main Methods:
- A multicentre cross-sectional survey of 1482 patients across six hospital wards in Conakry (June-October 2024).
- Antibiotic use categorized by Anatomic Therapeutic Chemical (ATC) and AWaRe classifications.
- Logistic regression analyzed factors associated with antibiotic prescription.
Main Results:
- Overall antibiotic prescription prevalence was 35.0%, significantly higher in inpatients (83.4%) than outpatients (25.1%).
- Most prescribed antibiotics included beta-lactams/beta-lactamase inhibitors (24.2%) and third-generation cephalosporins (21.7%).
- Nearly all (99.4%) antibiotic courses were empirical; 64.3% were Access, and 33.3% were Watch group antibiotics.
Conclusions:
- Conakry hospitals show a high prevalence of antibiotic prescriptions, predominantly empirical, especially among inpatients.
- Findings emphasize the critical need for implementing and strengthening antimicrobial stewardship programs.
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