Prescription of Levofloxacin and Moxifloxacin in Select Hospitals in Uganda: A Pilot Study to Assess Guideline Concordance.

Victoria Nambasa,Allan Serwanga,Diana Nakitto,Helen B Ndagije,Ronald Kiguba,Albert Figueras,Joanitah Atuhaire,Leonard Manirakiza

doi:10.3390/antibiotics9080439

Victoria Nambasa, Allan Serwanga + Show 6 more

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https://doi.org/10.3390/antibiotics9080439

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Abstract

Background: In Uganda, national tuberculosis (TB) treatment guidelines were revised to include the newer generation fluoroquinolones among the second-line treatment options for multidrug-resistant TB. This study was designed to analyze if the prescription of these quinolones is compliant with country recommendations. Methods: This was an observational retrospective study of consumption data for 2017 and 2018 across four selected regional referral hospitals. The sources of consumption data were hospital pharmacy stock cards and the dispensing register. The medical files of patients who had been prescribed fluoroquinolones were also assessed to study compliance with the Uganda Clinical Guidelines and the British National Formulary (BNF). Results: None of the 371 levofloxacin prescriptions analyzed complied with the Uganda Clinical Guidelines, although 250 (67.3%) were prescribed for indications included in the BNF. According to WHO prescription indicators, only 220 (59.3%) prescriptions were appropriate. Conclusion: The prescription of levofloxacin and moxifloxacin increased in the hospitals studied, but in a high proportion of cases, they were not compliant with country recommendations. The findings call for the strengthening of national antimicrobial stewardship programs.

Highlights

Tuberculosis (TB) is one of the world’s leading causes of adult morbidity and mortality [1]
A recent study analyzing the pattern of point mutations in 80 isolates of M. tuberculosis from Eswatini, Somalia, and Uganda found that the frequency of fluoroquinolone resistance mutations is high relative to global estimates, and they occurred independently of gyrA/QRDR mutations, implying that their absence in panels of molecular tests for detecting fluoroquinolone resistance may yield false negative results in our setting [10]
The findings revealed an increased use of fluoroquinolones, especially levofloxacin, for the management of common bacterial infections other than MDR/XDR-TB

Summary

Introduction

Tuberculosis (TB) is one of the world’s leading causes of adult morbidity and mortality [1]. Uganda’s Clinical Guidelines (UCG) were revised to incorporate fluoroquinolones, the newer-generation fluoroquinolones (levofloxacin, moxifloxacin, and gatifloxacin), as core medicines in both first and second-line treatment for MDR/XDR-TB; the use of these antibiotics for other clinical indications is discouraged [3,4]. A cross-sectional study of more than 300 patients with urinary tract infections from the Gulu Regional Referral Hospital in Uganda showed that only 51% of the isolates were sensitive to ciprofloxacin, but 67% were sensitive to levofloxacin [11]. In Uganda, national tuberculosis (TB) treatment guidelines were revised to include the newer generation fluoroquinolones among the second-line treatment options for multidrug-resistant TB. Results: None of the 371 levofloxacin prescriptions analyzed complied with the Uganda Clinical Guidelines, 250

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