Hospital prescribing patterns of antibiotics in Zambia using the WHO prescribing indicators post-COVID-19 pandemic: findings and implications

Abstract

Background: Antimicrobial resistance (AMR) is a global public health problem that is fuelled by the inappropriate prescribing of antibiotics especially those from the 'Watch' and 'Reserve' antibiotic list. The irrational prescribing of antibiotics is particularly prevalent in developing countries, including Zambia. Consequently, there is a need to better understand prescribing patterns across sectors in Zambia as a basis for future interventions. This study evaluated the prescribing patterns of antibiotics using the WHO prescribing indicators alongside the Access, Watch, and Reserve (AWaRe) classification system post-COVID pandemic at a Faith-based Hospital in Zambia. Methods: A cross-sectional study was conducted from August 2023 to October 2023 involving the review of medical records at St. Francis Mission Hospital in Zambia. A WHO-validated tool was used to evaluate antibiotic prescribing patterns alongside the AWaRe classification tool. Results: Out of 800 medical records reviewed, 2003 medicines were prescribed. Each patient received an average of 2.5 medicines per prescription. Antibiotics were prescribed in 72.3% of encounters, of which 28.4% were injectable. The most frequently prescribed antibiotics were amoxicillin (23.4% - Access), metronidazole (17.1% - Access), ciprofloxacin (8% - Watch), and ceftriaxone (7.4% - watch), with 77.1% overall from the 'Access' list. Encouragingly, 96.5% of the medicines were prescribed by their generic names and 98% were from the Zambia Essential Medicines List. Conclusions: There were high rates of antibiotic prescribing including injectable antibiotics, which needs addressing going forward. It is crucial to implement targeted measures, including antimicrobial stewardship programs, to improve future antibiotic prescribing in Zambia and reduce the risk of AMR.

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This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

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DOI

https://doi.org/10.1093/jacamr/dlae023

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https://strathprints.strath.ac.uk/88099/