Abstract
ObjectiveTo examine prescription patterns and explore to what extent guidelines are available and how they might influence treatment appropriateness among hospitalised patients in Kenyan hospitals. MethodsData on antimicrobial usage were collected from hospitalised patients across 14 Kenyan public hospitals. For each prescription, appropriateness of treatment was defined using available local and international treatment guidelines and through consensus with local medical specialists. Association between appropriate treatment, guideline availability and other possible explanatory factors was explored using univariate and multiple regression analysis. ResultsThere were 1675 (46.7%) of the 3590 hospitalised patients on antimicrobials with 3145(94%) of the 3363 antimicrobial prescriptions being antibiotics. Two patients (0.1%), had treatment based on available antibiotic susceptibility tests. Appropriate treatment was assessed in 1502 patients who had a single diagnosis. Of these, 805 (53.6%) received appropriate treatment. Physical availability of treatment guidelines increased the odds of receiving appropriate treatment Odds Ratio 6.44[95% CI 4.81–8.64]. ConclusionAppropriate antibiotic prescription remains a challenge in Kenyan public hospitals. This may be improved by the availability of context-specific, up-to-date, and readily accessible treatment guidelines across all the departments, and by providing better diagnostic support.
Highlights
Antimicrobial resistance (AMR) is an emerging global challenge that is thought to account for more than 700,000 deaths annually (O’neill, 2014)
Inappropriate use has been fuelled by lack of surveillance and diagnostic capabilities, poor antibiotic stewardship activities and lack of treatment
Factors associated with treatment appropriateness In keeping with our primary interest, we explored whether the physical availability of treatment guidelines was associated with treatment appropriateness and included the number of comorbidities, gender, and duration of hospital stay as additional explanatory factors
Summary
Antimicrobial resistance (AMR) is an emerging global challenge that is thought to account for more than 700,000 deaths annually (O’neill, 2014). To measure antibiotic use and quality of prescriptions at hospital and patient level, point prevalence surveys (PPS) have been extensively used (Gharbi et al, 2016; Okoth et al, 2018). They are easy to administer and, in addition to generating data on antibiotic use, can highlight other problematic aspects of quality of care, including the quality of prescription. We set out to conduct an antibiotic point prevalence survey across 14 public hospitals in Kenya, examine prescription quality and explore to what extent guidelines are available and how they might influence treatment appropriateness.
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