Appropriateness of antibiotic prescribing and compliance to guidelines at a referral hospital in Kenya : a point prevalence survey

Background: A large proportion of antibiotics globally are prescribed, dispensed or administered irrationally. This is partly due to lack of local guidelines or non-adherence to available antibiotic use guidelines. The irrational use of antibiotics results in wastage of scarce health care resources, increases the risk of adverse drug reactions and increases the potential of development of resistance. This leads to poor health outcomes. Objectives: The aim of the study was to establish whether there was rational or irrational prescribing and adherence to guidelines in one of the referral hospitals in Kenya at a specific point in time. Methods: A point prevalence survey was conducted at a referral hospital in Kenya in April 2017. Stratified proportionate random sampling technique was used to select eligible patients who were on systemic antibiotics. Data was abstracted from the patient medical records into a predesigned patient form. Associations between predictor variables such as socio-demographic factors and outcome variables such as rational prescribing and guideline compliance were determined using Chi square. Stepwise backward binary logistic regression was done to determine the independent predictors of rational antibiotic prescribing and guideline compliance. Statistical significance was set at 95% confidence level and values with p≤0.05 were considered statistically significant. Approval to conduct the study was obtained from the Kenyatta National Hospital/University of Nairobi Research and Ethics Committee. Results: A total of 179 patients were recruited into the study. There was rational prescribing in 33.9% (n=121) of all the 357 antibiotic encounters. The neonatal medical ward had the highest prevalence of rational prescribing (80%, n=12) while the critical care unit had the highest prevalence of irrational prescribing (100%, n=4). The most powerful predictor variables of rational antibiotic prescribing were the department (AOR=0.778, 95% CI=0.640–0.945, p=0.011), a diagnosis of a neonatal infection (AOR=5.992, 95% CI=1.985–18.094, p=0.001), a diagnosis of skin, soft tissue, bone and joint infection (AOR=6.221, 95% CI=2.053–18.847, p=0.001) and a diagnosis of no defined site such as sepsis (AOR=5.540, 95% CI=1.486–20.648, p=0.011). There was guideline compliance in 45.8% (n=82) of the study population. The most powerful predictors of guideline compliance were a diagnosis of a respiratory infection (AOR=7.141, 95% CI=2.950–17.287, p<0.001), a diagnosis of a neonatal infection (AOR=10.603, 95% CI=1.671–67.280, p=0.012) and a diagnosis of a skin, soft tissue, one and joint infections (AOR=5.606, 95% CI=1.730–18.162, p=0.004). Conclusions: Rational prescribing was documented in only a third of all antibiotics prescribed. There was poor compliance to guidelines. Local guidelines were not available for a significant proportion of conditions. International guidelines were used in such scenarios

Antibiotic prescribing patterns at a referral hospital in Kenya : a point prevalence survey

Background: Antibiotics are important in prevention and treatment of infections and the reduction in associated morbidity and mortality. Inappropriate use can lead to antimicrobial resistance, rendering them ineffective. Studies have shown variations in antibiotic prescribing patterns across different patient populations within the same hospital. Objectives: Our study aimed at establishing the prevalence and patterns of antibiotic use in a referral hospital in Kenya, with the aim of using the data for quality improvement. Methods: A point prevalence survey was conducted at a referral hospital in Kenya in April 2017. All patients who received antibiotics were recruited from all departments. Descriptive and inferential data analysis was done to establish the patterns of antibiotic use and the associations between variables. Ethical approval was obtained from the Kenyatta National Hospital/ University of Nairobi Research and Ethics Committee. Results: A hundred and seventy nine patients were enrolled in the study. The prevalence of antibiotic prescribing was 54.7%. The highest prevalence of antibiotic prescribing was found in critical care unit and isolation ward, both at 100%. Obstetrics and gynecology department had the least prevalence at 20.8%. Penicillins (46.9%) followed by cephalosporins (44.7%) were the most prescribed antibiotic classes. A larger proportion of antibiotic prescribing was for treatment (75.4%) as compared to prophylaxis (29.0%). Majority (76.9%, n=52) of the patients on surgical prophylaxis were on prolonged duration (>1 day). Empiric prescribing accounted for 82.6% of the total antibiotic encounters while targeted treatment was recorded in 17.4%. Conclusions: The study identified several areas for potential improvement in antibiotic prescribing such as the high prevalence of inpatient antibiotic use, prolonged duration of antibiotic use in surgical prophylaxis, extensive prescribing of broad spectrum agents such as ceftriaxone and the low prevalence of targeted antibiotic prescribing