Abstract
Background: High levels of antimicrobial resistance (AMR) in Ghana require the exploration of new approaches to optimise antimicrobial prescribing. This study aims to establish the feasibility of implementation of different delayed/back-up prescribing models on antimicrobial prescribing for upper respiratory tract infections (URTIs). Methods: This study was part of a quality improvement project at LEKMA Hospital, Ghana, (Dec 2019–Feb 2020). Patients meeting inclusion criteria were assigned to one of four groups (Group 0: No prescription given; Group 1; Patient received post-dated antibiotic prescription; Group 2: Offer of a rapid reassessment of patient by a nurse practitioner after 3 days; and Group 3: Post-dated prescription forwarded to hospital pharmacy). Patients were contacted 10 days afterwards to ascertain wellbeing and actions taken, and patients were asked rate the service on a Likert scale. Post-study informal discussions were conducted with hospital staff. Results: In total, 142 patients met inclusion criteria. Groups 0, 1, 2 and 3 had 61, 16, 44 and 21 patients, respectively. Common diagnosis was sore throat (73%). Only one patient took antibiotics after 3 days. Nearly all (141/142) patients were successfully contacted on day 10, and of these, 102 (72%) rated their experiences as good or very good. Informal discussions with staff revealed improved knowledge of AMR. Conclusions: Delayed/back-up prescribing can reduce antibiotic consumption amongst outpatient department patients with suspected URTIs. Delayed/back-up prescribing can be implemented safely in low and middle-income countries (LMICs).
Highlights
Resistance to antimicrobials poses a substantial threat to individual and public health.Antimicrobial resistance (AMR) is responsible for around 700,000 deaths globally per annum—this figureAntibiotics 2020, 9, 773; doi:10.3390/antibiotics9110773 www.mdpi.com/journal/antibioticsAntibiotics 2020, 9, 773 is predicted to rise to 10 million by 2050 if current trends continue unabated [1] with a disproportionately heavier burden in developing countries [2]
Upper respiratory tract infections (URTIs) antibiotic prescriptions account for the vast majority of antibiotic prescribing—usually in primary care [4]—where they are frequently prescribed for conditions where there is limited evidence of benefit, including acute otitis media and pharyngitis, and where there is no evidence of benefit, such as the common cold [5,6,7]
There were four different models of delayed/back-up prescribing—no prescription given; post-dated prescriptions being given to patients at time of first clinical appointment to use if no symptom resolution 3 days after clinic visit; rapid access to a nurse-led clinic for re-assessment after three days, i.e., if symptoms did not improve/patient’s condition deteriorate; and prescription forwarded to the hospital pharmacy and clinician/nurse practitioner asking patient to visit the hospital pharmacy to collect a pre-written antibiotic prescription if symptoms did not improve within 3 days
Summary
Resistance to antimicrobials poses a substantial threat to individual and public health.Antimicrobial resistance (AMR) is responsible for around 700,000 deaths globally per annum—this figureAntibiotics 2020, 9, 773; doi:10.3390/antibiotics9110773 www.mdpi.com/journal/antibioticsAntibiotics 2020, 9, 773 is predicted to rise to 10 million by 2050 if current trends continue unabated [1] with a disproportionately heavier burden in developing countries [2]. Upper respiratory tract infections (URTIs) antibiotic prescriptions account for the vast majority of antibiotic prescribing—usually in primary care [4]—where they are frequently prescribed for conditions where there is limited evidence of benefit, including acute otitis media and pharyngitis, and where there is no evidence of benefit, such as the common cold [5,6,7]. Delayed/back-up prescribing (where antibiotics can be accessed at a later time after the initial consultation) [8] is one strategy that can be implemented to reduce antibiotic prescribing. Current British National Institute for Clinical Excellence (NICE) guidance suggests that a delayed antibiotic prescribing strategy “encourages self-management . High levels of antimicrobial resistance (AMR) in Ghana require the exploration of new approaches to optimise antimicrobial prescribing. This study aims to establish the feasibility of implementation of different delayed/back-up prescribing models on antimicrobial prescribing for upper respiratory tract infections (URTIs).
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
