Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future

doi:10.3390/antibiotics11121824

. 2022 Dec 15;11(12):1824.

doi: 10.3390/antibiotics11121824.

Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future

Zikria Saleem¹, Brian Godman^{2

3

4}, Aislinn Cook^{5

6}, Muhammad Arslan Khan⁷, Stephen M Campbell^{4

8

9}, Ronald Andrew Seaton^{10

11}, Linda Siachalinga¹², Abdul Haseeb¹³, Afreenish Amir¹⁴, Amanj Kurdi^{2

4

15

16}, Julius C Mwita¹⁷, Israel Abebrese Sefah¹⁸, Sylvia A Opanga¹⁹, Joseph O Fadare^{20

21}, Olayinka O Ogunleye^{22

23}, Johanna C Meyer^{4

24}, Amos Massele²⁵, Dan Kibuule²⁶, Aubrey C Kalungia²⁷, Moyad Shahwan^{3

28}, Hellen Nabayiga²⁹, Giuseppe Pichierri³⁰, Catrin E Moore⁵

Affiliations

¹ Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan.
² Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK.
³ Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates.
⁴ Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa.
⁵ Centre for Neonatal and Paediatric Infection, St. George's University of London, London SW17 0RE, UK.
⁶ Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK.
⁷ The Indus Hospital, Bedian Road, Lahore 54000, Pakistan.
⁸ Centre for Epidemiology and Public Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK.
⁹ NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK.
¹⁰ Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK.
¹¹ Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK.
¹² College of Pharmacy, Yeungnam University, Daehak-Ro, Gyeongsan, Gyeongbuk 38541, Republic of Korea.
¹³ Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia.
¹⁴ Department of Microbiology, Armed Forces Institute of Pathology, National University of Medical Sciences, Rawalpindi 46000, Pakistan.
¹⁵ Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil 44001, Iraq.
¹⁶ Center of Research and Strategic Studies, Lebanese French University, Erbil 44001, Iraq.
¹⁷ Department of Internal Medicine, Faculty of Medicine, University of Botswana, Private Bag 0713 UB, Gaborone 00704, Botswana.
¹⁸ Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Hohoe PMB 31, Ghana.
¹⁹ Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi P.O. Box 19676-00202, Kenya.
²⁰ Department of Pharmacology and Therapeutics, Ekiti State University, Ado Ekiti 362103, Nigeria.
²¹ Department of Medicine, Ekiti State University Teaching Hospital, Ado Ekiti 360211, Nigeria.
²² Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos 100271, Nigeria.
²³ Department of Medicine, Lagos State University Teaching Hospital, Ikeja 100271, Nigeria.
²⁴ South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa.
²⁵ Department of Clinical Pharmacology and Therapeutics, Hurbert Kairuki Memorial University, 70 Chwaku Road Mikocheni, Dar Es Salaam P.O. Box 65300, Tanzania.
²⁶ Department of Pharmacology & Therapeutics, Busitema University, Mbale P.O. Box 236, Uganda.
²⁷ Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia.
²⁸ Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman 346, United Arab Emirates.
²⁹ Management Science Department, Strathclyde Business School, University of Strathclyde, 199 Cathedral Street, Glasgow G4 0QU, UK.
³⁰ Microbiology Department, Torbay and South Devon Foundation Trust, Lowes Bridge Torbay Hospital, Torquay TQ2 7AA, UK.

PMID: 36551481
PMCID: PMC9774141
DOI: 10.3390/antibiotics11121824

Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future

Zikria Saleem et al. Antibiotics (Basel). 2022.

. 2022 Dec 15;11(12):1824.

doi: 10.3390/antibiotics11121824.

Authors

Affiliations

¹ Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan.
² Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK.
³ Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates.
⁴ Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa.
⁵ Centre for Neonatal and Paediatric Infection, St. George's University of London, London SW17 0RE, UK.
⁶ Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK.
⁷ The Indus Hospital, Bedian Road, Lahore 54000, Pakistan.
⁸ Centre for Epidemiology and Public Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK.
⁹ NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK.
¹⁰ Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK.
¹¹ Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK.
¹² College of Pharmacy, Yeungnam University, Daehak-Ro, Gyeongsan, Gyeongbuk 38541, Republic of Korea.
¹³ Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia.
¹⁴ Department of Microbiology, Armed Forces Institute of Pathology, National University of Medical Sciences, Rawalpindi 46000, Pakistan.
¹⁵ Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil 44001, Iraq.
¹⁶ Center of Research and Strategic Studies, Lebanese French University, Erbil 44001, Iraq.
¹⁷ Department of Internal Medicine, Faculty of Medicine, University of Botswana, Private Bag 0713 UB, Gaborone 00704, Botswana.
¹⁸ Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Hohoe PMB 31, Ghana.
¹⁹ Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi P.O. Box 19676-00202, Kenya.
²⁰ Department of Pharmacology and Therapeutics, Ekiti State University, Ado Ekiti 362103, Nigeria.
²¹ Department of Medicine, Ekiti State University Teaching Hospital, Ado Ekiti 360211, Nigeria.
²² Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos 100271, Nigeria.
²³ Department of Medicine, Lagos State University Teaching Hospital, Ikeja 100271, Nigeria.
²⁴ South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa.
²⁵ Department of Clinical Pharmacology and Therapeutics, Hurbert Kairuki Memorial University, 70 Chwaku Road Mikocheni, Dar Es Salaam P.O. Box 65300, Tanzania.
²⁶ Department of Pharmacology & Therapeutics, Busitema University, Mbale P.O. Box 236, Uganda.
²⁷ Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia.
²⁸ Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman 346, United Arab Emirates.
²⁹ Management Science Department, Strathclyde Business School, University of Strathclyde, 199 Cathedral Street, Glasgow G4 0QU, UK.
³⁰ Microbiology Department, Torbay and South Devon Foundation Trust, Lowes Bridge Torbay Hospital, Torquay TQ2 7AA, UK.

PMID: 36551481
PMCID: PMC9774141
DOI: 10.3390/antibiotics11121824

Abstract

There are serious concerns with rising antimicrobial resistance (AMR) across countries increasing morbidity, mortality and costs. These concerns have resulted in a plethora of initiatives globally and nationally including national action plans (NAPs) to reduce AMR. Africa is no exception, especially with the highest rates of AMR globally. Key activities in NAPs include gaining a greater understanding of current antimicrobial utilization patterns through point prevalence surveys (PPS) and subsequently instigating antimicrobial stewardship programs (ASPs). Consequently, there is a need to comprehensively document current utilization patterns among hospitals across Africa coupled with ASP studies. In total, 33 PPS studies ranging from single up to 18 hospitals were documented from a narrative review with typically over 50% of in-patients prescribed antimicrobials, up to 97.6% in Nigeria. The penicillins, ceftriaxone and metronidazole, were the most prescribed antibiotics. Appreciable extended prescribing of antibiotics up to 6 days or more post-operatively was seen across Africa to prevent surgical site infections. At least 19 ASPs have been instigated across Africa in recent years to improve future prescribing utilizing a range of prescribing indicators. The various findings resulted in a range of suggested activities that key stakeholders, including governments and healthcare professionals, should undertake in the short, medium and long term to improve future antimicrobial prescribing and reduce AMR across Africa.

Keywords: Africa; antimicrobial resistance; antimicrobial stewardship programs; antimicrobials; national action plans; quality indicators; strategies; surgical site infections; utilization patterns.

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Conflict of interest statement

The authors declare no relevant conflict of interest.

Figures

**Figure 1**
Key principles for indicator development for antimicrobials across Africa (adapted from [56,124,125,126,127]). NB: Created via Biorender (https://biorender.com/) with permission granted to Catrin Moore (accessed on 14 November 2022)).

See this image and copyright information in PMC

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References

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[1] Hofer U. The cost of antimicrobial resistance. Nat. Rev. Microbiol. 2019;17:3. doi: 10.1038/s41579-018-0125-x. - DOI - PubMed

[2] Hofer U. The cost of antimicrobial resistance. Nat. Rev. Microbiol. 2019;17:3. doi: 10.1038/s41579-018-0125-x. - DOI - PubMed

[3] Murray C.J., Ikuta K.S., Sharara F., Swetschinski L., Aguilar G.R., Gray A., Han C., Bisignano C., Rao P., Wool E., et al. Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. Lancet. 2022;399:629–655. doi: 10.1016/S0140-6736(21)02724-0. - DOI - PMC - PubMed

[4] Murray C.J., Ikuta K.S., Sharara F., Swetschinski L., Aguilar G.R., Gray A., Han C., Bisignano C., Rao P., Wool E., et al. Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. Lancet. 2022;399:629–655. doi: 10.1016/S0140-6736(21)02724-0. - DOI - PMC - PubMed

[5] Cassini A., Högberg L.D., Plachouras D., Quattrocchi A., Hoxha A., Simonsen G.S., Colomb-Cotinat M., Kretzschmar M.E., Devleesschauwer B., Michele Cecchini M., et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: A population-level modelling analysis. Lancet Infect. Dis. 2019;19:56–66. doi: 10.1016/S1473-3099(18)30605-4. - DOI - PMC - PubMed

[6] Cassini A., Högberg L.D., Plachouras D., Quattrocchi A., Hoxha A., Simonsen G.S., Colomb-Cotinat M., Kretzschmar M.E., Devleesschauwer B., Michele Cecchini M., et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: A population-level modelling analysis. Lancet Infect. Dis. 2019;19:56–66. doi: 10.1016/S1473-3099(18)30605-4. - DOI - PMC - PubMed

[7] Founou R.C., Founou L.L., Essack S.Y. Clinical and economic impact of antibiotic resistance in developing countries: A systematic review and meta-analysis. PLoS ONE. 2017;12:e0189621. doi: 10.1371/journal.pone.0189621. - DOI - PMC - PubMed

[8] Founou R.C., Founou L.L., Essack S.Y. Clinical and economic impact of antibiotic resistance in developing countries: A systematic review and meta-analysis. PLoS ONE. 2017;12:e0189621. doi: 10.1371/journal.pone.0189621. - DOI - PMC - PubMed

[9] Nkengasong J.N., Tessema S.K. Africa Needs a New Public Health Order to Tackle Infectious Disease Threats. Cell. 2020;183:296–300. doi: 10.1016/j.cell.2020.09.041. - DOI - PMC - PubMed

[10] Nkengasong J.N., Tessema S.K. Africa Needs a New Public Health Order to Tackle Infectious Disease Threats. Cell. 2020;183:296–300. doi: 10.1016/j.cell.2020.09.041. - DOI - PMC - PubMed

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Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future

Affiliations

Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future

Authors

Affiliations

Abstract

Conflict of interest statement

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