Compliance to Guidelines in Prescribing Empirical Antibiotics for Individuals with Uncomplicated Urinary Tract Infection in a Primary Health Facility of Ghana, 2019-2021

Abstract

Increasing trends in antimicrobial resistance among uropathogens call for rational use of empirical antibiotics for managing uncomplicated urinary tract infections (UTIs). In Ghana, standard treatment guidelines (STGs) for UTI recommend oral ciprofloxacin or cefuroxime for 5-7 days in females and 10-14 days in males. We conducted a cross-sectional audit using electronic medical records (EMR) to assess compliance to the STGs among adults (≥18 years) with uncomplicated UTIs diagnosed in a primary health facility between October 2019 and October 2021. Among 3717 patients, 71% were females and all had complete prescription details in the EMR. Of all the patients, 83% were prescribed empirical antibiotics, of whom 88% received oral ciprofloxacin or cefuroxime. Only 68% were prescribed antibiotics for the correct duration, which was significantly lower among males (10%) compared to females (90%). Among patients who received antibiotics, 60% were prescribed in line with the STGs. The results call for feedback to physicians about poor compliance to STGs with duration of antibiotic prescribed. Recommendations on 10-14 days duration of antibiotics for males needs to be reassessed and necessary amendments to STGs can be made. Leveraging the well-established EMR system, a real-time audit-feedback mechanism can be instituted to improve compliance with STGs.

Keywords: Ghana; West Africa; antimicrobial resistance; antimicrobial stewardship; audit-feedback mechanism; compliance; electronic medical records; operational research; sort it; urinary tract infections.

Figure 1

Flow-chart depicting empirical antibiotic prescription and adherence to the STGs among adults diagnosed with uncomplicated UTIs in the outpatient department of the Korle Bu Polyclinic/Family Medicine Department of Ghana during October 2019 to October 2021. * Prescription of antibiotic of any class by the treating physician; # Prescription of either oral ciprofloxacin or cefuroxime as recommended in the STGs; $ Prescription of either oral ciprofloxacin or cefuroxime recommended at the dose, frequency, and duration as recommended in the STGs; UTI = Urinary Tract Infection; STGs = Standard Treatment Guidelines.