The use of antibiotics and the pattern of antimicrobial resistance at S.D.A Hospital, Kumasi, Ghana

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Objectives of Study To assess the current antibiotic prescribing and use pattern and the extent of microbial resistance to antibiotics at the Seventh-Day Adventist (SDA) Hospital in Kumasi. Also to obtain data that will serve as a basis for designing intervention to improve the quality of antibiotic prescribing and use at the hospital. Methods All the patients who were admitted between 1st March to 15th April 2013 and consented to participation in the study were included. Total number of patients involved was 176. Data on antibiotic prescribing and use was extracted from the medical notes, nursing notes and medication sheets of the patients followed by interviews with prescribers, other health professionals or the patients when necessary. Also laboratory data on antibiotic susceptibility testing was analyzed to assess the extent of antimicrobial resistance at the hospital. Results The average number of drugs per prescription for the patients in this study was 5. In all 82% of the prescriptions given to the patients contained antibiotic. Average number of antibiotics per prescription was 1.6. Ciprofloxacin was the most commonly prescribed antibiotic followed by cefuroxime and ceftriaxone. With regards to combination therapy, ciprofloxacin and metronidazole was the most prescribed and also used by the patients. Out of the 145 patients who received antibiotics during the study, none of the prescriptions was informed by culture and sensitivity results. Analysis of the culture and sensitivity data obtained from the lab indicated that Esherichia coli, Staphyllococcus aureus and Salmonella were the most pathogenic organisms isolated for patients at the hospital. All the three isolates (Esherichia coli, Staphyllococcus aureus and Salmonella) were mostly susceptible to gentamicin, cefotaxime, and ceftriaxone but resistant to ampicillin, chloramphenicol, cotrimoxazole, tetracycline and erythromycin and to some extent cefuroxime. Conclusion Polypharmacy practice was high at the hospital, and the use of antibiotics which were mostly given empirically was also too high. In addition, the study suggested widespread microbial resistance to many common antibiotics including a second generation cepholosporins. There is the need to establish protocols to guide the prescribing and judicious use of antibiotics in the hospital, and thus minimize waste and the risk of spread of microbial resistance to effective and life saving antibiotics currently available in the Ghanaian health system.
A thesis submitted to the Department of Clinical and Social Pharmacy, Kwame Nkrumah University of Science and Technology in partial fulfillment of the requirements for the degree of Master of Science in Clinical Pharmacy Faculty of Pharmacy and Pharmaceutical Sciences,