A cross-sectional study on the prevalence of antibiotic use prior to laboratory tests at two Ghanaian hospitals

Abstract

There has been a significant rise in global antibiotic use in recent years. Development of resistance has been linked to easy accessibility, lack of regulation of sale, increased tendency to self-medicate and the lack of public knowledge. The increase in antibiotic misuse, including self-medication, has not been well documented in developing countries. Antibiotic use prior to visiting health facilities has been found to be prevalent in developing countries. It has been identified by some studies to increase the likelihood of missed diagnoses and influence the outcome of bacteriological tests. This study is aimed at determining the prevalence of prior antibiotic use through a cross-sectional survey of patients undergoing laboratory tests at two health facilities in Ghana. Face-to-face questionnaires were used to interview 261 individuals chosen by random sampling of patients visiting the bacteriology laboratory of the hospitals within a two-month period. The questionnaire investigated participant demographic characteristics, knowledge about antibiotics and the nature of antibiotic use. Antibiotic property detection bioassay was performed on patient’s urine sample using a disk diffusion method to accurately determine antibiotic use within 72 hours. Culture results were used as an index to evaluate the effect of prior antibiotic use on bacteriological tests. Out of a 261 participants enrolled, 19.9% (95% CI, 14.9–24.9) acknowledged using antibiotics prior to their visit to the laboratory during the study period. On the contrary, 31.4% (95% CI, 25.7–37.5) of participants’ urine samples were positive for antimicrobial activity. Participants within the age ranges of 20–30, 31–40 and 41–50 years had significantly lower odds of urine antimicrobial activity. Participants who had urine antimicrobial activity were more likely to have no growth on their culture plates than participants who had no urine antimicrobial activity [OR 2.39(1.37–4.18), p = 0.002]. The most commonly used antibiotics were the penicillins, fluoroquinolones and metronidazole. Although, majority of the participant (54.8%) had knowledge of antibiotics, most of them had inadequate information on their proper use. The commonest indications for antibiotic use were aches and pains (30.3%), diarrhoea (43.3%) and urinary tract infections (28.0%). Prior antibiotic use was found to increase the likelihood of obtaining a culture negative result and can affect the outcome of bacteriological tests.

Knowledge, attitudes and practices regarding antimicrobial use and resistance among healthcare seekers in two tertiary hospitals in Ghana: a quasi-experimental study

“…We argue that although our study participants seemed to have a general knowledge about antibiotic use and resistance, this knowledge did not seem to matter much for some participants when considering the use of antibiotics when ill. Therefore, we agree with prior studies6 10 43 suggesting the need for an intervention to promote attitudinal changes in antibiotic use. A solution may be to provide more persuasive information which in addition to the health consequences of AMR must include the economic implications of inappropriate antibiotic use.…”

Sexually transmitted infections and prior antibiotic use as important causes for negative urine cultures among adults presenting with urinary tract infection symptoms to primary care clinics in Zimbabwe: a cross-sectional study

“… 18 This suggests that asking patients about antimicrobials may not be sufficient in determining prior exposure as shown in findings from Ghana. 19 On the other hand, the antibiotic bioassay may overestimate antimicrobial use for treatment of infections by also detecting antimicrobials consumed unintentionally in food and water. 20 Alternative explanations for symptoms suggestive of UTIs such as dysuria include irritant hygienic products, spermicides and certain foods.…”

Prevalence of self-medication in Ghana: a systematic review and meta-analysis

“…Like in most LMICs, Ghanaians are likely to try home remedies as the initial health-seeking behaviour and are likely to self-medicate while taking prescribed medicines 50 51. Alarmingly, this practice could lead to drug toxicity, drug–drug contraindications and reduced efficacy of prescribed medicines 12 52…”