Impact of antimicrobial stewardship interventions to improve antibiotic prescribing for hospital inpatients in Africa: a systematic review and meta-analysis

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

“…The number of PPS studies have grown across Africa over time ( Table S1 ) despite concerns with available resources and personnel, providing future guidance, and this acceleration will continue. In addition, we are seeing the number of successful ASPs increase across Africa ( Table 3 ), despite again initial concerns regarding available financial resources and personnel to conduct ASPs in LMICs, providing exemplars to others [ 128 , 132 , 137 , 138 ]. This will continue as part of NAPs to reduce rising AMR rates across Africa [ 2 , 70 ].…”

“…However, there can be concerns instigating ASPs, with issues of resources, manpower, and knowledge among key stakeholders especially among low- and middle-income countries (LMICs) including African countries ( Box S1—Supplementary Material ) [ 128 , 129 , 130 , 131 ]. This though is also starting to change among African countries as well as among other LMICs [ 111 , 132 , 133 , 134 , 135 , 136 , 137 ]. We are likely to see more ASPs being instigated across Africa and beyond as part of NAPs to reduce AMR, enhanced by the availability of toolkits from the WHO and others [ 67 , 70 , 132 , 137 , 138 , 139 , 140 ].…”

“…This though is also starting to change among African countries as well as among other LMICs [ 111 , 132 , 133 , 134 , 135 , 136 , 137 ]. We are likely to see more ASPs being instigated across Africa and beyond as part of NAPs to reduce AMR, enhanced by the availability of toolkits from the WHO and others [ 67 , 70 , 132 , 137 , 138 , 139 , 140 ].…”

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

“…Evidence shows that ASPs, when well planned, implemented, and evaluated, lead to improvements in antibiotic use in hospital settings across Africa ( Table S2 ). Notwithstanding the numerous structural and logistical challenges associated with implementing ASPs in LMICs, including Africa [ 23 ], there is a case to be made for well-planned, sufficiently resourced, and team-led ASPs to be implemented in Zambian hospitals building on successful approaches across Africa ( Table S2 ) [ 26 , 29 ]. Moreover, an urgent need exists to enhance infection prevention and control (IPC) practices among hospitals across Zambia with concerns that excessive intubation, and the use of other invasive devices, enhance the potential for hospital-acquired infections [ 49 , 64 ].…”

“…In addition, concerns with knowledge regarding ASPs among key hospital personnel [ 24 , 25 ]. However, this is changing with ASPs increasingly being undertaken among African countries to good effect, including reducing extended prophylaxis to prevent SSIs [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. More recently, there have been moves to assess current antimicrobial prescribing based on the WHO AWaRE categorization as targets for quality improvement programmes to reduce the unnecessary prescribing of ‘Watch’ and ‘Reserve’ antibiotics and their associated resistance potential [ 21 , 34 , 35 , 36 ].…”