Evaluation of Ceftriaxone Utilization in Three Regional Referral Hospitals in Uganda: A Prospective Multicentre Study

This study evaluated Ceftriaxone use in Regional Referral Hospitals (RRHs) in Uganda against treatment guidelines, identified drivers of irrational use, and provided evidence-based recommendations to inform a future framework for improving Ceftriaxone utilization.

We conducted a prospective mixed-methods study in three RRHs. Quantitative data on Ceftriaxone use were collected using structured questionnaires from 753 inpatients, while key informant interviews explored factors influencing inappropriate use and mitigation strategies in place. Quantitative data were summarized using proportions, means, and standard deviations. Logistic regression analyses (univariate and multivariate) were conducted to determine factors associated with appropriate dosing, frequency, combination therapy, and prescribing. Qualitative data were analysed using content analysis to identify emerging themes.

Overall, appropriate Ceftriaxone use was 68.5% (516/753). Ceftriaxone was mostly prescribed for surgical prophylaxis (41%), as 2 g doses (65.7%), once daily (97.7%), for 5 days (53%). Complete blood count was the most performed test (70.4%); culture and sensitivity testing was only 1%. Appropriate use was associated with the admission ward (surgical; AOR=4.55, p<0.0001), and the hospital; Lacor RRH (AOR=2.4, p=0.016), and Hoima RRH (AOR=2.6, p=0.002). Staying in hospital >7 days reduced odds of appropriate use (AOR=0.5, p=0.047). Drivers of inappropriate use included lack of prescription restrictions, non-adherence to guidelines, inadequate supervision, poor drug administration, stockouts, heavy workloads, and limited prescriber knowledge.

Ceftriaxone was appropriately used in 68.5% of cases across three RRHs, indicating suboptimal adherence to national guidelines. A national framework should include prescription restrictions, strengthened culture and sensitivity capacity, and antimicrobial stewardship training for all prescribers.