Assessment of antibiotic use at Tamale Teaching Hospital.
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Date
2017-01-24
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Abstract
Antimicrobial resistance is a major problem worldwide
due to indiscriminate and widespread use of antimicrobials both in healthcare facilities
and in communities. Tamale Teaching Hospital (TTH) is a major referral center for
hospitals in and around the northern parts of the country. This study therefore seeks to
investigate and evaluate the pattern of antibacterial medicines prescribed for infections
management, and the quality of use of these agents at the hospital.
This was a non-randomised observational study undertaken from June 2
to July 14, 2015. The design was cross-sectional and duration of data collection was six
(6) weeks. Four hundred (400) in-patients from all the four directorates of the hospital
were selected. The patients involved in the study were either diagnosed of having an
infection or prescribed antibacterials and consented to participate in the study. The
patients were then followed on daily basis for data on antimicrobial use until they were
discharged, transferred out of the hospital or died. Appropriateness of antibacterial use
was evaluated based on recommendations in the Standard Treatment Guidelines of
Ghana (STG) 2010 and British National Formulary (BNF 69). The latter was recognized
universally and adopted by clinicians at TTH.
The most common infections diagnosed were respiratory tract infections
(16.5%, n=66), gastrointestinal tract infections (16.5%, n=66), sepsis (10.2%, n=41) and
infections associated with spontaneous vaginal delivery (8.8%, n=35). In all, 1120 out of
3572 in-patients encountered within the study period were prescribed antibacterial
agents representing a prevalence of 31.35%. Almost all the prescriptions (99.8%, n=876)
were from the Essential Medicines List (EML), 99.2% (n=871) was also based on the
National Health Insurance Medicines List (NHIML). 45.3% (n=181) of the patients were
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prescribed 2 antibacterials, 24.0% (n=96) and 22.0% (n=88) were prescribed 3 and 1
antibacterial(s) respectively. The remaining (8.7%, n=35) were on 4 or more
antibacterial agents. The most prescribed antimicrobial was metronidazole (26.3%,
n=232), followed by Amoxicillin/Clavulanic acid (15.7%, n=139), then ceftriaxone
(15%, n=132), cefuroxime (11.4%, n=101) and ciprofloxacin (11%, n=97). 79% (n=316)
of the participants prescriptions were in line with recommendations in STG 2010 and
BNF 69, and 21% (n=84) was not. Ninety one percent had their symptoms resolved
after antibacterial therapy (n=364), and 9.0% (n=36) still had symptoms after
antibacterial therapy. Of the 400 patients recruited, only 27 (6.8%) had samples taken
for culture and sensitivity tests to guide antibacterial therapy. Common hospital flora
including Escherichia coli and Staphylococcus Aureus were isolated and found to be
resistant to CAGN (Co-trimoxazole, Ampicillin, Gentamycin, Nalidixic acid) and
C2CFAG (Cefuroxime, Co-trimoxazole, Flucloxacillin, Ampicillin, Gentamycin)
respectively. The average length of stay was 6.1days with 41.5% (n=166)) spending 1-3
days and 35% (n=140) spending 4-7 days at the hospital, and the remaining 23.5%
spending more than 7 days at the hospital.
Description
A thesis submitted to the Department of Clinical
and Social Pharmacy, Faculty of Pharmacy and
Pharmaceutical Sciences, Kwame Nkrumah
University of Science and Technology, in partial
fulfilment of the requirements for the award of
master of science in clinical pharmacy, 2016.