Antibiotic Use and Resistance Pattern in Ethiopia: Systematic Review and Meta-Analysis

Abstract

Background: In the last decades, medicines have had an unprecedented positive effect on health, leading to reduced mortality and disease burden and consequently to an improved quality of life. The rapid and ongoing spread of antimicrobial-resistant organisms threatens our ability to successfully treat a growing number of infectious diseases. In the absence of the development of new generations of antibiotic drugs, appropriate use of existing antibiotics is needed to ensure the long-term availability of effective treatment for bacterial infections. Irrational use of antibiotics is an ongoing global public health problem that deserves more attention. This review is conducted to evaluate the prevalence of inappropriate antibiotic utilization and resistance to antibiotics in Ethiopia.

Methods: Electronic search in PubMed/MEDLINE and Google was used to find published literature with reference lists of relevant articles searched manually. Titles and abstracts were initially screened for eligibility. The full texts of articles judged to be eligible were reviewed if they meet the inclusion criteria. Data were extracted on important variables like the sample size, region of the study, the inappropriate antibiotic use, bacterial detection rate, multidrug resistance pattern, and more other variables. Microsoft Excel was used for data extraction. Quantitative analysis was performed using STATA version 11.

Results: The electronic searches identified 193 articles of which 33 were found eligible. The random-effects model was used to provide point estimates (with 95% confidence interval (CI)) of bacterial detection rate, inappropriate antibiotic use, and multidrug resistance rate to account for heterogeneity. The pooled bacteria detection rate was 29.1 with 95% CI (16.6-41.7). The pooled prevalence of multidrug resistant strains identified was 59.7% (95% CI: 43.5-75.9). The pooled estimate of inappropriate antibiotic use was 49.2% (95% CI: 32.2-66.2). The pooled proportion of self-antibiotic prescription was 43.3% (95% CI: 15.7-70.9). Other reasons for inappropriate antibiotic use included a wrong indication, wrong duration, improper route of administration, use of leftover antibiotics from a family member, and immature discontinuation of antibiotics.

Conclusion and recommendations: Inappropriate antibiotic use is a huge problem in Ethiopia, and many bacteria were resistant to commonly used antibiotics and similarly, multidrug-resistant bacterial strains are numerous. Appropriate antibiotic use should be ensured by prohibiting over-the-counter sale of antibiotics and strengthening antimicrobial stewardship.

Figure 1

Funnel plot of studies showing the within-study biases.

Figure 2

A flow diagram of the selection of eligible studies.

Figure 3

Forest plot 1: bacterial detection rate of studies. LCL: lower confidence interval; UCL: upper confidence interval; WGHT: weight of the study.

Figure 4

Forest plot 2: multidrug-resistant strains in the studies. LCL: lower confidence interval; UCL: upper confidence interval; WGHT: weight of the study.

Figure 5

Forest plot 3: Inappropriate antibiotic use in the studies. LCL: lower confidence interval; UCL: upper confidence interval; WGHT: weight of the study.