A narrative review of recent antibiotic prescribing practices in ambulatory care in Tanzania : findings and implications

Background and objectives: There are concerns with current prescribing of antibiotics in ambulatory care in Tanzania, including both the public and private sectors. These concerns need to be addressed as part of the National Action Plan (NAP) of Tanzania to reduce rising antimicrobial resistance (AMR) rates. Issues and concerns include high rates of prescribing of antibiotics for essentially self-limiting conditions. Consequently, there is a need to address this. As a result, the aims of this narrative review were to comprehensively summarize antibiotic utilization patterns particularly in ambulatory care, their rationale and to suggest ways forward to improve future prescribing. Materials and Methods: We undertook a narrative review of recently published studies and subsequently documented potential activities to improve future prescribing. Potential activities included instigating quality indicators and antimicrobial stewardship programs (ASPs). Results: Published studies have shown that antibiotics are being excessively prescribed in ambulatory care, in up to 95% to 96.3% of presenting cases depending on the sector. This is despite concerns with their appropriateness. High rates of antibiotic prescribing are not helped by variable adherence to current treatment guidelines. There have also been concerns with extensive prescribing of ‘Watch’ antibiotics in the private sector. Overall, the majority of antibiotics prescribed across the sectors, albeit in-appropriately, were typically from the ‘Access’ group of antibiotics in the AWaRe (Ac-cess/Watch/Reserve) classification rather than ‘Watch’ antibiotics to limit AMR. Inappropriate pre-scribing of antibiotics in ambulatory care is linked with current knowledge regarding antibiotics, AMR and ASPs among both prescribers and patients. Recommended activities for the future include improved education for all groups, instigation of updated quality indicators and regular monitoring of prescribing against agreed-upon guidelines and indicators. Education for healthcare professionals on ASPs should start in universities and continue post qualification. Community advocacy on the rational use of antibiotics should also include social media activities to dispel misinformation. Conclusion: The quality of current prescribing of antibiotics in ambulatory care is sub-optimal in Tanzania. This urgently needs to be addressed