Adherence to SATS antibiotic recommendations in patients with community acquired pneumonia in Johannesburg, South Africa

Mukansi, Murimisi; Chetty, Anastacia; Feldman, Charles

doi:10.3855/jidc.6637

Cited by 5 publications

(6 citation statements)

References 15 publications

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“…Antibiotics were almost universally prescribed when indicated and adherence to recommended regimens was comparable or higher than other studies. [12,20–27] Similar to other published data, antibiotics were also frequently prescribed to children without an indication. [24–26] A high proportion of antibiotic prescriptions for children with diarrhea and malaria could be explained by differential diagnoses requiring empiric antibiotic treatment.…”

Section: Discussionsupporting

confidence: 69%

A mixed method multi-country assessment of barriers to implementing pediatric inpatient care guidelines

et al. 2019

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IntroductionAccelerating progress in reducing child deaths is needed in order to achieve the Sustainable Development Goal child mortality target. This will require a focus on vulnerable children–including young children, those who are undernourished or with acute illnesses requiring hospitalization. Improving adherence to inpatient guidelines may be an important strategy to reduce child mortality, including among the most vulnerable. The aim of our assessment of nine sub-Saharan African and South Asian hospitals was to determine adherence to pediatric inpatient care recommendations, in addition to capacity for and barriers to implementation of guideline-adherent care prior to commencing the Childhood Acute Illness and Nutrition (CHAIN) Cohort study. The CHAIN Cohort study aims to identify modifiable risk factors for poor inpatient and post discharge outcomes above and beyond implementation of guidelines.MethodsHospital infrastructure, staffing, durable equipment, and consumable supplies such as medicines and laboratory reagents, were evaluated through observation and key informant interviews. Inpatient medical records of 2–23 month old children were assessed for adherence to national and international guidelines. The records of children with severe acute malnutrition (SAM) were oversampled to reflect the CHAIN study population. Seven core adherence indicators were examined: oximetry and oxygen therapy, fluids, anemia diagnosis and transfusion, antibiotics, malaria testing and antimalarials, nutritional assessment and management, and HIV testing.ResultsAll sites had facilities and equipment necessary to implement care consistent with World Health Organization and national guidelines. However, stockouts of essential medicines and laboratory reagents were reported to be common at some sites, even though they were mostly present during the assessment visits. Doctor and nurse to patient ratios varied widely. We reviewed the notes of 261 children with admission diagnoses of sepsis (17), malaria (47), pneumonia (70), diarrhea (106), and SAM (119); 115 had multiple diagnoses. Adherence to oxygen therapy, antimalarial, and malnutrition refeeding guidelines was >75%. Appropriate antimicrobials were prescribed for 75% of antibiotic-indicative conditions. However, 20/23 (87%) diarrhea and 20/27 (74%) malaria cases without a documented indication were prescribed antibiotics. Only 23/122 (19%) with hemoglobin levels meeting anemia criteria had recorded anemia diagnoses. HIV test results were infrequently documented even at hospitals with universal screening policies (66/173, 38%). Informants at all sites attributed inconsistent guideline implementation to inadequate staffing.ConclusionAssessed hospitals had the infrastructure and equipment to implement guideline-consistent care. While fluids, appropriate antimalarials and antibiotics, and malnutrition refeeding adherence was comparable to published estimates from low- and high-resource settings, there were inconsistencies in implementation of some other recommendations. Stockou...

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Section: Discussionsupporting

confidence: 69%

A mixed method multi-country assessment of barriers to implementing pediatric inpatient care guidelines

et al. 2019

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“…Consistent with the manner in which the South African health system is configured (Figure 1) [45], the study findings demonstrated that access and diagnosis points to lung cancer care remain the major barriers, with the cancer diagnostic services only offered at high levels of care [20,58]. Patients are expected to initiate their health-seeking from the primary healthcare clinics before progressing to subsequent levels, a phenomenon that is time consuming and not unique to SA [9,30,46,[59][60][61][62]. This phenomenon culminates in patients being diagnosed with cancer at advanced stages [19,21,23,24,[29][30][31]34,36,40,41].…”

Section: Discussionsupporting

confidence: 67%

“…The healthcare provided at primary healthcare clinics is of low quality, owing to limitations pertaining to infrastructure and expertise. This, in turn, prolongs the time to receiving specialized patient care available at tertiary and quaternary facilities [19,21,23,24,[29][30][31]34,36,40,41]. These bottlenecks often result in deaths before patients' access to tertiary hospitals, where advanced diagnostic procedures and treatments are administered [45,46].…”

Section: Introductionmentioning

confidence: 99%

“…However, the downside to it may be the delay in getting cancer patients diagnosed and treated in a timely manner [45,46]. Whereas stage at diagnosis is a strong predictor of survival, delaying the referral pathway could increase the risk of stage progression and poorer clinical outcomes [12,15,16,19,[21][22][23]26,29,30,34,35,41,47]. The illustration indicates the hierarchy of access to health care services.…”

Section: Introductionmentioning

confidence: 99%

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Improving Timely Access to Diagnostic and Treatment Services for Lung Cancer Patients in KwaZulu-Natal, South Africa: Priority-Setting through Nominal Group Techniques

Lubuzo

Hlongwana

Ginindza

2022

IJERPH

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Background: Lung cancer is the most common cancer worldwide, and it disproportionately affects low-income countries (LICs), where over 58% of cases occur. It is an important public health concern, given its poor healthcare outcomes, yet it is under-researched compared to other cancers. Lung cancer is also very difficult for primary care physicians to diagnose. In many settings, health researchers and clinicians’ resort to engaging in collaborative efforts to determine the best way to implement evidence into routine clinical practice. Methods: This was a grounded theory study comprising seven experts providing oncological services. A Nominal Group Technique (NGT) was used to articulate ideas, identify key problems and reach consensus on the order of priorities for the identified problems. Results: The study findings revealed that access to healthcare facilities providing oncology services and diagnosis was the major barrier to lung cancer care. This was further exacerbated by the manner in which health systems are configured in South Africa. The priorities for the health providers were focused on the lack of specialized resources, whereby referral of patients suspected to have lung cancer was delayed and compounded by the limited availability of treatment. Conclusion: The inadequacy of supportive systems for access to healthcare services negates the government efforts to curb the rising lung cancer-related fatalities in South Africa.

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“…[101112] The compliance rate of empiric antibiotic use in CAP was very low (6.4%) in one study from Europe in 2006[13] and was 66% in a study from South Africa. [14] Adherence to CAP guidelines was associated with better prognosis in the short term, especially in patients requiring mechanical ventilation. [15] The rate of initial ICU admission of CAP patients was low (2.8%) in the present study.…”

Section: Discussionmentioning

confidence: 99%

Empiric antibiotic therapy in the treatment of community-acquired pneumonia in a general hospital in Saudi Arabia

Al‐Tawfiq

Momattin

Hinedi

2019

J Global Infect Dis

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Background: Guideline-based empiric antimicrobial therapy is recommended for the treatment of community-acquired pneumonia (CAP). In this study, we evaluate the pattern of empiric antibiotics of CAP patients. Materials and Methods: Patients with CAP were retrieved from the health information unit using the International Classification of Diseases, Ninth Revision. The electronic pharmacy database was used to retrieve prescribed antibiotics and the duration of therapy for each antibiotic. Results: A total of 1672 adult patients were included in the study and 868 (52%) were male. Of all the patients, 47 (2.8%) were admitted to the intensive care unit (ICU). The most frequently used antibiotics were levofloxacin (68.12%), ceftriaxone (37.7%), imipenem-cilastatin (32.5%), and azithromycin (20.6%). The mean days of therapy of each of these antibiotics were 3.2, 2.8, 4.4, and 2.9, respectively. A combination therapy of levofloxacin and imipenem-cilastatin was prescribed for 355 (21.8%) of non-ICU patients versus 20 (60.6%) of ICU patients ( P = 0.0007). Imipenem-cilastatin was prescribed for 518 (31.8%) of non-ICU patients versus 25 (56.8%) of ICU patients ( P = 0.0009). Levofloxacin was prescribed for 1106 (68%) of non-ICU patients versus 33 (75%) of ICU patients ( P = 0.412). Ceftriaxone use decreased significantly from 40.9% in 2013 to 25.9% in 2016 ( P = 0.034). In addition, levofloxacin use increased from 63.7% to 75% ( P = 0.63). Conclusion: The most commonly used antibiotics were levofloxacin, ceftriaxone, imipenem-cilastatin, and azithromycin. The data call for further refinement and prospective audit of antibiotic use in CAP, especially in non-ICU settings.

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Adherence to SATS antibiotic recommendations in patients with community acquired pneumonia in Johannesburg, South Africa

Cited by 5 publications

References 15 publications

A mixed method multi-country assessment of barriers to implementing pediatric inpatient care guidelines

A mixed method multi-country assessment of barriers to implementing pediatric inpatient care guidelines

Improving Timely Access to Diagnostic and Treatment Services for Lung Cancer Patients in KwaZulu-Natal, South Africa: Priority-Setting through Nominal Group Techniques

Empiric antibiotic therapy in the treatment of community-acquired pneumonia in a general hospital in Saudi Arabia

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