Antibiotic use and consumption among medical patients of two hospitals in Sierra Leone: a descriptive report

• Published in: BMC infectious diseases 2023-10, Vol.23 (1), p.737-737, Article 737
• Main Authors: Lakoh, Sulaiman, Williams, Christine Ellen Elleanor, Sevalie, Stephen, Russell, James B W, Conteh, Sarah K, Kanu, Joseph Sam, Barrie, Umu, Deen, Gibrilla F, Maruta, Anna, Sesay, Daniel, Adekanmbi, Olukemi, Jiba, Darlinda F, Okeibunor, Joseph Chukwudi, Yendewa, George A, Firima, Emmanuel
• Format: Article
• Language: English
• Subjects: ACCESS, WATCH and RESERVE (AWaRe); Adult; Analysis; Anti-Bacterial Agents - therapeutic use; Antibiotic consumption; Antibiotics; Antimicrobial agents; Antimicrobial resistance; Antimicrobial resistance (AMR); Bacterial diseases; Bacterial infections; Care and treatment; Ceftriaxone; Classification; Consumption; Consumption data; Cross-Sectional Studies; Data analysis; Data collection; Defined daily dose (DDD); Diagnosis; Drug resistance in microorganisms; Drug therapy; Drug Utilization; Evaluation; Female; Health aspects; Health services; Hospital patients; Hospitals; Hospitals, Public; Humans; Infections; Information management; Intensive care; Levofloxacin; Low income areas; Male; Medical research; Medicine, Experimental; Metronidazole; Middle Aged; Pandemics; Patients; Population; Prescription writing; Questionnaires; Sierra Leone; Sierra Leone - epidemiology; Tuberculosis
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-023-08517-0

Although one of the main drivers of antimicrobial resistance is inappropriate antibiotic prescribing, there are limited resources to support the surveillance of antibiotic consumption in low-income countries. In this study, we aimed to assess antibiotic use and consumption among medical patients of two hospitals in different geographic regions of Sierra Leone. This is a cross-sectional study of adult (18 years or older) patients receiving medical care at two hospitals (34 Military Hospital-MH and Makeni Government Hospital-MGH) between March 2021 and October 2021. After admission to the medical or intensive care unit, patients were sequentially recruited by a nurse from each hospital. Demographic and clinical characteristics and information on the dose of antibiotics, their routes, and frequency of administration and duration were collected using a questionnaire adapted from previous studies and encrypted in EpiCollect software (Epic, Verona WI). A physician reviews and verifies each completed questionnaire. Data analysis was done using STATA version 16. The mean age of the 468 patients evaluated in this study was 48.6 years. The majority were women (241, 51.7%) and treated at MGH (245, 52.0%). Clinical diagnosis of bacterial infection was made in only 180 (38.5%) patients. Regardless of the diagnosis, most (442, 94.9%) patients received at least one antibiotic. Of a total 813 doses of antibiotics prescribed by the two hospitals, 424 (52.2%) were administered in MH. Overall, antibiotic consumption was 66.9 defined daily doses (DDDs) per 100 bed-days, with ceftriaxone being the most commonly used antibiotic (277, 34.1%). The ACCESS and WATCH antibiotics accounted for 18.9 DDDs per 100 bed-days (28.2%) and 48.0 DDDs per 100 bed-days (71.7%), respectively. None of the patients were prescribed a RESERVE antibiotics. The antibiotic consumption was lower in MH (61.3 DDDs per 100 bed-days) than MGH (76.5 DDDs per 100 bed-days). Antibiotic consumption was highest with ceftriaxone, followed by levofloxacin and metronidazole. Given the high rate of consumption of antibiotics in the WATCH category of the AWaRe classification, there is a need to initiate surveillance of antibiotic consumption and establish hospital-based antibiotic stewardship in these settings.