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. 2022 Mar;34(1):3-8.
doi: 10.4314/mmj.v34i1.2.

Antibiotic guideline adherence by Clinicians in medical wards at Queen Elizabeth Central Hospital (QECH), Blantyre Malawi

Grace Thandekire Sibande  1 , Ndaziona Peter Kwanjo Banda  1   2 , Thandizo Moya  1 , Sylvia Siwinda  1 , Rebecca Lester  3   4
Affiliations

Antibiotic guideline adherence by Clinicians in medical wards at Queen Elizabeth Central Hospital (QECH), Blantyre Malawi

Grace Thandekire Sibande et al. Malawi Med J. 2022 Mar.

Abstract

Antimicrobial resistance (AMR) is a major concern in health care worldwide. In Malawi rates of AMR, in particular third-generation cephalosporin-resistant (3GC-R) Enterobacterales have rapidly increased since 2003. Antibiotic guidelines are a key component of antimicrobial stewardship (AMS). As part of stewardship, Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi developed an antibiotic guideline in the form of a smart phone application in June 2016.

Aim: We conducted a study to assess clinicians adherence to the local antibiotic guideline on the adult medical wards, two years after it was introduced. Specifically assessing choice of antibiotic, time of blood culture collection and 48-hour review.

Methods: A cross-sectional study was carried out using purposive sampling method. 230 case files of adult patients were audited against the antibiotic guideline. Adherence to the guideline in terms of indication for antibiotic, choice of antibiotic and antibiotic review time was reviewed. Statistical analysis was done using IBM SPSS and presented with descriptive statistics.

Results: 194 (84% [95% CI 79.0-88.8]) antibiotic prescriptions were adherent to the guideline, 28 (12% [95% CI 8.2-17.1]) non-adherent and 8 (3.5% [95% CI 1.5-6.7]) antibiotic indication was not clear. The most common indication for antibiotic prescriptions was pneumonia, as documented in 89 (39% [95 % CI 32.4-45.3]) case files. 191(76% [95% CI 70.3-81.2]) of prescriptions were for ceftriaxone. There was evidence of utilising blood culture to adjust therapy as 88/230 (38% [95% CI 32.0-44.9]) had culture taken. 175(76% [95 % CI 70.0-81.4]) of files had antibiotics reviewed within 48 hours.

Conclusion: There is still need to work on rational prescribing of antibiotics as ceftriaxone usage was high during this study period. Scheduled audits and point prevalence surveys should be implemented quickly to reduce the impact of antibiotic resistance and improve individual patient care.

Keywords: Antibiotic guideline; Antibiotic resistance; Antimicrobial stewardship; sub-Saharan Africa.

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Conflict of interest statement

All authors declare that they have no competing interest related to this work conflict. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Figures

Figure 1
Figure 1
Name of antibiotics prescribed throughout the study period
See this image and copyright information in PMC

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