Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov 4;9(11):773.
doi: 10.3390/antibiotics9110773.

Implementation of a Delayed Prescribing Model to Reduce Antibiotic Prescribing for Suspected Upper Respiratory Tract Infections in a Hospital Outpatient Department, Ghana

Sam Ghebrehewet  1 , Wendi Shepherd  1   2 , Edwin Panford-Quainoo  2 , Saran Shantikumar  3 , Valerie Decraene  4 , Rajesh Rajendran  5 , Menaal Kaushal  6 , Afua Akuffo  6 , Dinah Ayerh  6 , George Amofah  6
Affiliations

Implementation of a Delayed Prescribing Model to Reduce Antibiotic Prescribing for Suspected Upper Respiratory Tract Infections in a Hospital Outpatient Department, Ghana

Sam Ghebrehewet et al. Antibiotics (Basel). .

Abstract

Background: High levels of antimicrobial resistance (AMR) in Ghana require the exploration of new approaches to optimise antimicrobial prescribing. This study aims to establish the feasibility of implementation of different delayed/back-up prescribing models on antimicrobial prescribing for upper respiratory tract infections (URTIs). Methods: This study was part of a quality improvement project at LEKMA Hospital, Ghana, (Dec 2019-Feb 2020). Patients meeting inclusion criteria were assigned to one of four groups (Group 0: No prescription given; Group 1; Patient received post-dated antibiotic prescription; Group 2: Offer of a rapid reassessment of patient by a nurse practitioner after 3 days; and Group 3: Post-dated prescription forwarded to hospital pharmacy). Patients were contacted 10 days afterwards to ascertain wellbeing and actions taken, and patients were asked rate the service on a Likert scale. Post-study informal discussions were conducted with hospital staff. Results: In total, 142 patients met inclusion criteria. Groups 0, 1, 2 and 3 had 61, 16, 44 and 21 patients, respectively. Common diagnosis was sore throat (73%). Only one patient took antibiotics after 3 days. Nearly all (141/142) patients were successfully contacted on day 10, and of these, 102 (72%) rated their experiences as good or very good. Informal discussions with staff revealed improved knowledge of AMR. Conclusions: Delayed/back-up prescribing can reduce antibiotic consumption amongst outpatient department patients with suspected URTIs. Delayed/back-up prescribing can be implemented safely in low and middle-income countries (LMICs).

Keywords: Ghana; LMICs; antimicrobial resistance (AMR); antimicrobial stewardship (AMS); delayed/back-up prescribing; developing countries; upper respiratory tract infections.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Attendance of Patients with upper respiratory tract infections (URTIs) at LEKMA Hospital, July 2019–June 2020.
See this image and copyright information in PMC

References

    1. Villegas M.V., Lyon S. Gram-Negative Infections: Evolving Treatments with Expanding Options. Futur. Sci. OA. 2018;4:2–5. doi: 10.4155/fsoa-2018-0071. - DOI - PMC - PubMed
    1. Pokharel S., Raut S., Adhikari B. Tackling Antimicrobial Resistance in Low-Income and Middle-Income Countries. BMJ Glob. Health. 2019;4:4–6. doi: 10.1136/bmjgh-2019-002104. - DOI - PMC - PubMed
    1. Dyar O.J., Huttner B., Schouten J., Pulcini C. What Is Antimicrobial Stewardship? Clin. Microbiol. Infect. 2017;23:793–798. doi: 10.1016/j.cmi.2017.08.026. - DOI - PubMed
    1. Public Health England English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) [(accessed on 1 August 2020)];2016 Available online: https://improvement.nhs.uk/resources/english-surveillance-programme-anti...
    1. Venekamp R.P., Sanders S.L., Glasziou P.P., Del Mar C.B., Rovers M.M. Antibiotics for Acute Otitis Media in Children. Cochrane Database Syst. Rev. 2015;2015:CD000219. doi: 10.1002/14651858.CD000219.pub4. - DOI - PMC - PubMed