Assessment of antibiotic use at Tamale Teaching Hospital.

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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 vii 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.
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.