Dear HIFA and HIFA-Zambia colleagues,
CITATION: Pharmacology & Pharmacy > Vol.13 No.10, October 2022
Antibiotic Prescribing Patterns in Adult Patients According to the WHO AWaRe Classification: A Multi-Facility Cross-Sectional Study in Primary Healthcare Hospitals in Lusaka, Zambia
Steward Mudenda et al.
Introduction: Indiscriminate prescribing and using of antibiotics have led to the development of antimicrobial resistance (AMR). To reduce this problem, the World Health Organization (WHO) developed the “Access”, “Watch”, and “Reserve” (AWaRe) classification of antibiotics that promotes antimicrobial stewardship (AMS). In Zambia, there are gaps in practice regarding prescribing of antibiotics based on the AWaRe protocol. This study assessed antibiotic prescribing patterns in adult in-patients in selected primary healthcare hospitals in Lusaka, Zambia. Materials and Methods: This retrospective cross-sectional study was conducted using 388 patient medical files from September 2021 to November 2021, five primary healthcare hospitals namely; Chawama, Matero, Chilenje, Kanyama, and Chipata. Data analysis was performed using the Statistical Package for Social Sciences version 23. Results: Of the selected medical files, 52.3% (n = 203) were for male patients. Overall, the prevalence of antibiotic use was 82.5% (n = 320) which was higher than the WHO recommendation of a less than 30% threshold. The most prescribed antibiotic was ceftriaxone (20.3%), a Watch group antibiotic, followed by metronidazole (17.8%) and sulfamethoxazole/trimethoprim (16.3%), both belonging to the Access group. Furthermore, of the total antibiotics prescribed, 41.9% were prescribed without adhering to the standard treatment guidelines. Conclusion: This study found a high prescription of antibiotics (82.5%) that can be linked to non-adherence to the standard treatment guidelines in primary healthcare hospitals. The most prescribed antibiotic was ceftriaxone which belongs to the Watch group, raising a lot of concerns. There is a need for rational prescribing of antibiotics and implementation of AMS programs in healthcare facilities in Zambia, and this may promote surveillance of irrational prescribing and help reduce AMR in the future.
COMMENT (NPW): This study highlights a lack of adherence to national guidelines, resulting in gross misuse of antibiotics. This is a major concern. What is needed is to better understand *why* health workers do not adhere to guidance? Do they have immediate access to such guidelines, and is the guidance in a format that is easy to use? What is the level of trust of health workers in the guidelines? What are other reasons for overprescription of antibiotics? Expectation from patients (who may not themselves be aware that antibiotics may be ineffective and even harmful in some cases)? Profit motivation (HIFA colleagues have previously emphasised the fact that prescription of drugs may bring added income to the health facility)?
Best wishes, Neil
Dr Neil Pakenham-Walsh, HIFA Coordinator
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