Antibiotic Prescribing Patterns in Ghana, Uganda, Zambia and Tanzania Hospitals: Results from the Global Point Prevalence Survey (G-PPS) on Antimicrobial Use and Stewardship Interventions Implemented

Abstract

Antimicrobial resistance (AMR) remains an important global public health issue with antimicrobial misuse and overuse being one of the main drivers. The Global Point Prevalence Survey (G-PPS) of Antimicrobial Consumption and Resistance assesses the prevalence and the quality of antimicrobial prescriptions across hospitals globally. G-PPS was carried out at 17 hospitals across Ghana, Uganda, Zambia and Tanzania. The overall prevalence of antimicrobial use was 50% (30–57%), with most antibiotics prescribed belonging to the WHO ‘Access’ and ‘Watch’ categories. No ‘Reserve’ category of antibiotics was prescribed across the study sites while antimicrobials belonging to the ‘Not Recommended’ group were prescribed infrequently. Antimicrobials were most often prescribed for prophylaxis for obstetric or gynaecological surgery, making up between 12 and 18% of total prescriptions across all countries. The most prescribed therapeutic subgroup of antimicrobials was ‘Antibacterials for systemic use’. As a result of the programme, PPS data are now readily available for the first time in the hospitals, strengthening the global commitment to improved antimicrobial surveillance. Antimicrobial stewardship interventions developed included the formation of AMS committees, the provision of training and the preparation of new AMS guidelines. Other common interventions included the presentation of findings to clinicians for increased awareness, and the promotion of a multi-disciplinary approach to successful AMS programmes. Repeat PPS would be necessary to continually monitor the impact of interventions implemented. Broader participation is also encouraged to strengthen the evidence base.

Point Prevalence Survey of Antibiotic Use across 13 Hospitals in Uganda

“…The prevalence of antibiotic use found in this study is high compared to what was found in high-income countries, but similar to findings in other low- and middle-income countries [ 33 ]. In contrast, a lower prevalence of antibiotic use was reported in other studies from Kenya (46.7%) [ 34 ]; Tanzania (44%) [ 35 ]; countries of Ghana, Uganda, Zambia, and Tanzania in the Global PPS (30–57%, with overall prevalence of 50%) [ 36 ]; Brazil (52.2%) [ 37 ]; Northern Ireland (46.2%) [ 38 ]; and Belgium (27.1%) [ 39 ]. Cross-national differences may be accounted for by factors such as varying disease burden, antibiotic use guidelines, and policies across countries, including ease of access to antibiotics, differences in patients’ characteristics, and types of hospitals.…”

Prevalence of bacterial coinfection and patterns of antibiotics prescribing in patients with COVID-19: A systematic review and meta-analysis

“…A total of 76,176 adult patients with RT-PCR confirmed COVID-19 were included from 22 studies, with studies by Russell et al [44] (UK, 48,902 patients) and Puzniak et al [34] (US, 17,003 patients) comprising 86.5% of the overall study population. The mean age of patients, was 61 years (IQR 59 67, range 36-74) and mean proportion of male subjects was 54% (IQR [50][51][52][53][54][55][56][57][58][59][60][61][62][63].…”

“…The increase in antibiotic use observed during this pandemic might have impacted and setback antimicrobial stewardship (AMS) efforts globally, especially in regions where AMS programmes are just starting as seen in Africa with previous knowledge and resource issues [56][57][58]. This is starting to change in Africa with a growing number of AMS activities to address identified concerns [59][60][61]. However, remarkably, in certain regions globally, specifically in Europe, there was a decline in antibiotic use overall in 2020, despite high antibiotic use in COVID-19 positive patients.…”

Prevalence of Bacterial Coinfection and Patterns of Antibiotics Prescribing in Patients with COVID-19: A Systematic review and Meta-Analysis

“…The increase in antibiotic use observed during this pandemic might have impacted and setback antimicrobial stewardship (AMS) efforts globally, especially in regions where AMS programmes are just starting as seen in Africa with previous knowledge and resource issues [61][62][63] . This is starting to change in Africa with a growing number of AMS activities to address identified concerns [64][65][66] . However, remarkably, in certain regions globally, specifically in Europe, there was a decline in antibiotic use overall in 2020, despite high antibiotic use in COVID-19 positive patients.…”