Sulaiman Lakoh1, Olukemi Adekanmbi2, Darlinda F Jiba3, Gibrilla F Deen4, Wadzani Gashau3, Stephen Sevalie5, Eili Y Klein6. 1. Department of Internal Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone; Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Sierra Leone; Sustainable Health Systems, Freetown, Sierra Leone. Electronic address: lakoh2009@gmail.com. 2. Department of Medicine, University of Ibadan, Nigeria. 3. Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Sierra Leone. 4. Department of Internal Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone; Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Sierra Leone. 5. 34 Military Hospital Freetown, Sierra Leone, Sierra Leone; Sustainable Health Systems, Freetown, Sierra Leone. 6. Center for Disease Dynamics, Economics & Policy, Washington, DC 20005, United States; Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21209, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States.
Abstract
OBJECTIVES: Our study aimed to assess antibiotic use in adult inpatients in the context of limited laboratory services at the main tertiary hospital in Sierra Leone. DESIGN: A cross-sectional study of consecutive adult inpatients (≥18 years) between October 2017 and February 2018 at Connaught Hospital in Freetown. RESULTS: A total of 920 patients were interviewed, of which 753 (81.8%) had at least one antibiotic. Complete data was captured for 688 (91.0%) patients. The median age was 41 years and 52.8% were male. Fever was reported in 41.5% of patients, though 85.1% had no leukocyte count prior to antibiotic use and none had a bacterial culture. Indications for prescribing were surgical prophylaxis (15.7%), pneumonia (15.1%), and trauma (5.8%). Cephalosporins (25.9%), penicillins (23.2%), and imidazoles (20.8%) were commonly prescribed. CONCLUSION: We found high rates of antibiotic use, of which most was not based on laboratory evidence. Lack of oversight and microbiological support are drivers of poor prescribing in many developing countries, which lack financial resources and serve a sicker population. Greater investments are needed to establish antimicrobial stewardship programs and provide clinicians with diagnostic support to enable improvements in patient outcomes and curb the spread of antibiotic resistance.
OBJECTIVES: Our study aimed to assess antibiotic use in adult inpatients in the context of limited laboratory services at the main tertiary hospital in Sierra Leone. DESIGN: A cross-sectional study of consecutive adult inpatients (≥18 years) between October 2017 and February 2018 at Connaught Hospital in Freetown. RESULTS: A total of 920 patients were interviewed, of which 753 (81.8%) had at least one antibiotic. Complete data was captured for 688 (91.0%) patients. The median age was 41 years and 52.8% were male. Fever was reported in 41.5% of patients, though 85.1% had no leukocyte count prior to antibiotic use and none had a bacterial culture. Indications for prescribing were surgical prophylaxis (15.7%), pneumonia (15.1%), and trauma (5.8%). Cephalosporins (25.9%), penicillins (23.2%), and imidazoles (20.8%) were commonly prescribed. CONCLUSION: We found high rates of antibiotic use, of which most was not based on laboratory evidence. Lack of oversight and microbiological support are drivers of poor prescribing in many developing countries, which lack financial resources and serve a sicker population. Greater investments are needed to establish antimicrobial stewardship programs and provide clinicians with diagnostic support to enable improvements in patient outcomes and curb the spread of antibiotic resistance.
Authors: Ibrahim Franklyn Kamara; Sia Morenike Tengbe; Bobson Derrick Fofanah; James Edward Bunn; Charles Kuria Njuguna; Christiana Kallon; Ajay M V Kumar Journal: Int J Environ Res Public Health Date: 2022-04-26 Impact factor: 4.614
Authors: Maike Winters; Ben Oppenheim; Paul Sengeh; Mohammad B Jalloh; Nance Webber; Samuel Abu Pratt; Bailah Leigh; Helle Molsted-Alvesson; Zangin Zeebari; Carl Johan Sundberg; Mohamed F Jalloh; Helena Nordenstedt Journal: BMJ Glob Health Date: 2021-11