Point prevalence survey of antimicrobial use in three hospitals in North-Eastern Tanzania

Abstract

Background Antimicrobial resistance (AMR) is one of the most urgent global health threats with low-resource countries being disproportionately affected. Targeted interventions require insight in antibiotic prescription practices. A point prevalence survey (PPS) is a well-known tool to get insight in antibiotic dispensing practices in hospitals and identify areas for improvement. Here, we describe the results of a PPS performed in a tertiary, regional and district hospital in Kilimanjaro region in Tanzania. Methods A PPS was performed in the Kilimanjaro Christian Medical Centre (KCMC; tertiary hospital), Mawenzi (regional) and St. Joseph (district) hospital in November and December 2016. Antibiotic use in all patients admitted more than 24 h and those undergoing surgery was recorded. All clinical wards were included except the pediatrics. Data from a single ward were collected on the same day. Results A total of 399 patients were included in the PPS: 232 patients from KCMC, 94 from Mawenzi hospital and 73 patients from St. Joseph hospital. Overall prevalence of antibiotic use was 44.0%: 38% in KCMC, 59% in Mawenzi and 63% in St. Joseph. Ceftriaxone (n = 94, 29.8%), metronidazole (n = 79, 23.9%) and other antibiotics belonging to the penicillin class (n = 89, 28.3%) were most commonly prescribed. Antibiotics prescribed for surgical prophylaxis were continued for more than 3 days in 57% of cases. Conclusion Our study shows a rate of broad-spectrum antibiotic use in Tanzanian hospitals and prolonged surgical antibiotic prophylaxis being a common practice. PPS is an important tool to improve future antibiotic use in Tanzania hospitals.

Seasonality and Annual Utilization Patterns of Antibacterials at Muhimbili National Hospital, Dar es Salaam, Tanzania: A 2015 Monthly Survey

“…However, there was a high rate (66%) of the utilization of broadspectrum antibacterials in this study. This may be due to antibacterials being frequently prescribed empirically without microbiological testing (15) in Tanzania. The prescribing and dispensing tendency at the hospital is more empirical because of the lack of appropriate technology such as culture sensitivity testing (15).…”

“…This may be due to antibacterials being frequently prescribed empirically without microbiological testing (15) in Tanzania. The prescribing and dispensing tendency at the hospital is more empirical because of the lack of appropriate technology such as culture sensitivity testing (15). Therefore, prescribers tend to provide empiric treatment, which may be inappropriate on some occasions.…”

“…The overuse of broad-spectrum antibacterials will eventually lead to a lack of alternative antibacterials choices, causing trivial bacterial infections to persist. This situation will cause mortality to even trivial infections (15). Study shows a rate of broadspectrum antibacterial use in Tanzanian hospitals and prolonged surgical antibacterial prophylaxis being a common practice (13,15,20).…”

“…Implementing ASP can exemplify the tendency of overdependence on newer expensive antibacterials for mild infections (3,10) and the unnecessary use of reserved antibacterials. However, ASP and data to support it are scarce in LMICs (14,15).…”

ABC-VEN Analysis of Medicine Expenditure at Mwananyamala Regional Hospital in Tanzania

“…Antibiotics are excessively prescribed and used even in the situation when there is no indication such as in non-bacterial infections (Mambile et al, 2016). For example, ceftriaxone injection, which was in category I and consumed 2% of the annual medicine expenditure is commonly used irrationally in Tanzania, contributing to the emergency of resistant strains (Horumpende et al, 2020;Sasi et al, 2019;Seni et al, 2020;Sonda et al, 2019). Hospitals need to ensure these high-cost medicines are controlled to ensure their rational use to reduce wastage of resources.…”