Bene D Anand Paramadhas1, Celda Tiroyakgosi2, Pinkie Mpinda-Joseph3, Mathudi Morokotso2, Matshediso Matome4, Fatima Sinkala5, Mavis Gaolebe5, Brighid Malone6, Emmanuel Molosiwa7, Muthu Guhan Shanmugam8, Gogaisa Pearl Raseatlholo9, Joyce Masilo10, Yomi Oyeniran11, Stella Marumoloa12, Omphile Glory Maakelo1, Ishmael Katjakae13, Joyce Kgatlwane14, Brian Godman15,16,17,18, Amos Massele19. 1. a Department of Pharmacy , Nyangabgwe Hospital , Francistown , Botswana. 2. b Botswana Essential Drugs Action Program , Ministry of Health and Wellness , Gaborone , Botswana. 3. c Infection Prevention and Control Program , Nyangabgwe Hospital , Francistown , Botswana. 4. d Managed Care , AFA , Gaborone , Botswana. 5. e Department of Pharmacy , Letsholathebe II Memorial Hospital , Maun , Botswana. 6. f Lenmed Bokamoso Private Hospital , Mmopane , Botswana. 7. g Department of Pharmacy , Mahalapye District Hospital , Mahalapye , Botswana. 8. h Department of Pharmacy , Deborah Retif Memorial Hospital , Mochudi , Botswana. 9. i Department of Pharmacy , Scottish Livingstone Hospital , Molepolole , Botswana. 10. j Department of Pharmacy , Bobonong Primary Hospital , Bobonong , Botswana. 11. k Department of Pharmacy , Goodhope Primary Hospital , Gaborone , Botswana. 12. l Department of Pharmacy , Lethlakane Primary Hospital , Letlhakane , Botswana. 13. m Department of Pharmacy , Gweta Primary Hospital , Gweta , Botswana. 14. n School of Pharmacy , University of Botswana , Gaborone , Botswana. 15. o Division of Clinical Pharmacology, Karolinska Institute , Karolinska University Hospital Huddinge , Huddinge , Sweden. 16. p Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK. 17. q Health Economics Centre , Liverpool University Management School , Liverpool , UK. 18. r School of Pharmacy , Sefako Makgatho Health Sciences University , Garankuwa , South Africa. 19. s Department of Biomedical Sciences, Faculty of Medicine , University of Botswana , Gaborone , Botswana.
Abstract
Objective: There is an urgent need to undertake Point Prevalence Surveys (PPS) across Africa to document antimicrobial utilisation rates given high rates of infectious diseases and growing resistance rates. This is the case in Botswana along with high empiric use and extended prophylaxis to prevent surgical site infections (SSIs) Method: PPS was conducted among all hospital sectors in Botswana using forms based on Global and European PPS studies adapted for Botswana, including rates of HIV, TB, malaria, and malnutrition. Quantitative study to assess the capacity to promote appropriate antibiotic prescribing. Results: 711 patients were enrolled with high antimicrobial use (70.6%) reflecting an appreciable number transferred from other hospitals (42.9%), high HIV rates (40.04% among those with known HIV) and TB (25.4%), and high use of catheters. Most infections were community acquired (61.7%). Cefotaxime and metronidazole were the most prescribed in public hospitals with ceftriaxone the most prescribed antimicrobial in private hospitals. Concerns with missed antibiotic doses (1.96 per patient), high empiric use, extended use to prevent SSIs, high use of IV antibiotics, and variable infrastructures in hospitals to improve future antibiotic use. Conclusion: High antibiotic use reflects high rates of infectious diseases observed in Botswana. A number of concerns have been identified, which are being addressed.
Objective: There is an urgent need to undertake Point Prevalence Surveys (PPS) across Africa to document antimicrobial utilisation rates given high rates of infectious diseases and growing resistance rates. This is the case in Botswana along with high empiric use and extended prophylaxis to prevent surgical site infections (SSIs) Method: PPS was conducted among all hospital sectors in Botswana using forms based on Global and European PPS studies adapted for Botswana, including rates of HIV, TB, malaria, and malnutrition. Quantitative study to assess the capacity to promote appropriate antibiotic prescribing. Results: 711 patients were enrolled with high antimicrobial use (70.6%) reflecting an appreciable number transferred from other hospitals (42.9%), high HIV rates (40.04% among those with known HIV) and TB (25.4%), and high use of catheters. Most infections were community acquired (61.7%). Cefotaxime and metronidazole were the most prescribed in public hospitals with ceftriaxone the most prescribed antimicrobial in private hospitals. Concerns with missed antibiotic doses (1.96 per patient), high empiric use, extended use to prevent SSIs, high use of IV antibiotics, and variable infrastructures in hospitals to improve future antibiotic use. Conclusion: High antibiotic use reflects high rates of infectious diseases observed in Botswana. A number of concerns have been identified, which are being addressed.
Entities:
Keywords:
Antibiotics; Botswana; antimicrobial resistance; antimicrobial stewardship programs; antimicrobial utilization; drugs and therapeutic committees; hospitals; point prevalence studies
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