Antibiotic Use and Stewardship Indicators in the First- and Second-Level Hospitals in Zambia: Findings and Implications for the Future

Abstract

Introduction: There are increasing concerns with growing rates of antimicrobial resistance (AMR) across Africa, including in Zambia, enhanced by inappropriate utilization of antibiotics across the sectors. There is a need in hospitals to document current prescribing patterns via point prevalence surveys (PPS) alongside recognized indicators to improve future use. The findings can subsequently be used to develop and instigate appropriate antimicrobial stewardship programs (ASPs) to improve the quality of future antimicrobial prescribing across Zambia. This includes encouraging the prescribing of ‘Access’ over ‘Watch’ and ‘Reserve’ antibiotics where pertinent. Methods: A PPS was undertaken using the WHO methodology among 10 first- and second-level public hospitals across the 10 provinces of Zambia. A sampling process was used to select the hospitals. Results: The prevalence of antibiotic use among the in-patients was 307/520 (59.0%), with a high rate of empiric prescribing of ceftriaxone at 36.1% of all antibiotics prescribed (193/534). The reason for antibiotic use was recorded in only 15.7% of occasions and directed treatment prescribed in only 3.0% of occasions. Compliance with the national standard treatment guidelines (STGs) was also low at only 27.0% of occasions. Conclusion: High empiric prescribing, limited documentation of the rationale behind antibiotic prescribing, high use of ‘Watch’ antibiotics, and limited compliance to STGs among surveyed hospitals requires the urgent instigation of ASPs across Zambia to improve future prescribing.

Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future

“…Antimicrobial utilization was typically high across most of the studied African countries (over 50% of patients), with similar rates in a recent study in Zambia [147]. Hospitals in Nigeria saw the highest antimicrobial utilization rates at 59.6-97.6% of in-patients surveyed Table 1.…”

Phenotypic and genotypic antibiotic susceptibility profiles of Gram-negative bacteria isolated from bloodstream infections at a referral hospital, Lusaka, Zambia

“…This use of 3GCs in primary care facilities promotes the emergence of 3GC-resistant pathogens thereby further limiting treatment options for patients being referred to tertiary hospital where 3GCs are widely used as empiric treatment [36]. Similar to the findings at the UTH and the primary care facilities in Lusaka [35,36], another study in Zambia that reviewed antibiotic use and stewardship indicators in the first-and second-level hospitals in ten provinces at ten different hospitals found the prevalence of antibiotic use among the in-patients to be at 59% with a high rate of empiric prescribing (97%), of which ceftriaxone was 36% of all antibiotics prescribed [37]. Low compliance to the national standard treatment guidelines (STGs), low justified antibiotic use at 16% and only 3% of the treatment having been guided by microscopy, culture and sensitivity (MCS).…”

“…Low compliance to the national standard treatment guidelines (STGs), low justified antibiotic use at 16% and only 3% of the treatment having been guided by microscopy, culture and sensitivity (MCS). Practices that drive the emergence of AMR [37].…”

World Health Organization AWaRe framework for antibiotic stewardship: Where are we now and where do we need to go? An expert viewpoint

“…From the Zambian point of view, implementation of the AWaRe tool is still in its infancy, but hospitals where prescribers adhered to this AMS strategy reported low AMR challenges. 7 Therefore, the political will demonstrated by the Government of the Republic of Zambia to support the implementation of this AMS strategy will further prevent and reduce AMR cases.…”

“…In Zambia, there are gaps and lack of knowledge among healthcare workers on the use the AWaRe tool because studies have reported high prescribing of Watch antibiotics. 7 , 8 , 10 In all studies, ceftriaxone, a Watch antibiotic, was being overused (Table 1 ). This contrasts with the WHO recommendations.…”