Prescribing Patterns of Antibiotics According to the WHO AWaRe Classification during the COVID-19 Pandemic at a Teaching Hospital in Lusaka, Zambia: Implications for Strengthening of Antimicrobial Stewardship Programmes

Abstract

Irrational and inappropriate prescribing of antibiotics is a major problem that can lead to the development of antimicrobial resistance (AMR). In Zambia, there is insufficient information on the prescribing patterns of antibiotics according to the World Health Organization (WHO) AWaRe classification. Therefore, this study assessed the prescribing patterns of antibiotics using the AWaRe classification during the COVID-19 pandemic at the University Teaching Hospital in Lusaka, Zambia. A cross-sectional study was conducted using 384 patient medical files at the University Teaching Hospital in Lusaka, Zambia, from August 2022 to September 2022. All antibiotics were classified according to the WHO “AWaRe” tool and assessed for appropriateness using the 2020 Zambian Standard Treatment Guidelines. Of the 384 patient medical files reviewed, antibiotics were prescribed 443 times. The most prescribed antibiotics were ceftriaxone (26.6%), metronidazole (22.6%), amoxicillin (10.4%), amoxicillin/clavulanic acid (5.6%), and azithromycin (5%). The prescribing of 42.1% of “Watch” group antibiotics was greater than the recommended threshold by the WHO. Most antibiotics were prescribed for respiratory infections (26.3%) and gastrointestinal tract infections (16.4%). The most prescribed antibiotic was ceftriaxone, a Watch antibiotic. This is a worrisome observation and calls for strengthened antimicrobial stewardship and implementation of the AWaRe framework in prescribing antibiotics.

Antibiotic prescribing patterns and carriage of antibiotic-resistant Escherichia coli and Enterococcus species in healthy individuals from selected communities in Lusaka and Ndola districts, Zambia

“…High levels of E. coli resistance to ampicillin and co-trimoxazole could be attributed to selective pressure resulting from misuse and overuse of antibiotics in the community and at primary healthcare facilities. 46 , 47 Comparable to our findings, a systematic review that analysed the prevalence of resistance to the top 10 antibiotics commonly prescribed in LMICs in commensal E. coli isolates from human sources in community settings found high resistance to ampicillin, co-trimoxazole and tetracycline. 48 Studies included in this systematic review were mostly from Asia ( n = 13) and Africa ( n = 10).…”

Community antibiotic consumption and associated factors in Lusaka district of Zambia: findings and implications for antimicrobial resistance and stewardship

“… 31 , 94 , 124–126 Additionally, the high use of antibiotics could be attributed to increased prescribing of antibiotics in healthcare facilities. 127 , 128 The high use of antibiotics in healthcare facilities continues to be reported across the world. 129–132 …”

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

“…Additionally, the lack of awareness of the WHO AWaRe framework of antibiotics influences healthcare workers to prescribe and dispense antibiotics without following the guidelines, worsening the AMR challenge. 5 , 8 Another major challenge is limited resources and capacity to implement the framework in many countries, especially in lower- and middle-income countries. 9 Additionally, the low availability of affordable and good-quality antibiotics affects the sustainable implementation of the AWaRe system.…”

“…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.…”