ANTIMICROBIAL PRESCRIPTION PREVALENCE AND PATTERNS FOR IN-PATIENTS IN HOSPITALS, YENAGOA, BAYELSA STATE, NIGERIA

Abstract

Inappropriate and excessive prescription of antimicrobial agents promotes the development of antimicrobial resistance (AMR) which worsens patients' prognosis and threatens modern medicine. Addressing the fourth focus area of Nigeria's National Action Plan against AMR requires documenting antimicrobial prescription prevalence and patterns in hospitals. A point prevalence survey (PPS) of antimicrobial prescribing (AMP) was conducted among in-patients' in 11 hospitals in Yenagoa, Bayelsa State. The prevalence of AMP was computed with the number of in-patients as denominator and number on antimicrobials as numerator. A key informant interview was conducted for Medical Directors in each hospital and Directors in the State Ministry of Health to identify some factors associated with the AMP prevalence and patterns. It covered three thematic areas: perception of AMP and AMR; knowledge of antimicrobial stewardship (AMS) and AMP policy; and intervention strategies. Patterns of prescribing were described based on hospital type, gender, age groups, diagnoses, indications for treatment, nature of therapy, type of antimicrobial agents, route of administration and number of agents per patient. Appropriateness of prescribing was assessed using three quality indicators: reason for prescribing was documented at start, stop/review date documented and treatment supported by microbiological testing. Prescriptions that had all three quality indicators were considered appropriate. There were 209 in-patients (public, 69 and private, 140) and 189 (public, 64 and private, 125) on antimicrobials, giving an AMP prevalence of 90.4% (public 92.8% and private 89.3%). Females were 59.7% of patients. Median age(± lQR) was 27 ± 32 years. There were therapeutic indications in 63% of prescriptions and empirical therapy in 75.7%. All 419 prescriptions were of broad spectrum antibacterials only for the 189 inpatients, and seven antimalarials prescribed 118 times for 94 of them with a mean (± SD) of 2.7 ± 1 antimicrobials per patient. The most frequently prescribed was Metronidazole (55.0% patients) followed by Ceftriaxone, Gentamicin and Ciprotloxacin (35.4%, 30.7% and 28.6% respectively). The parenteral route was utilised in 74.0% of patients. Only 4.8% of prescriptions were appropriate when assessed with three quality indicators. Therapeutic indications, empirical therapy, oral route of administration and private hospitals all showed some association with appropriate prescriptions on bivariate analysis. However, only the oral route and private hospitals were statistically significant on logistic regression. All key informants interviewed emphasized the need for an AMP policy and expressed unanimous interest to comply with it when available. There is unacceptably high prevalence of AMP with overuse of broad spectrum antibacterials and widespread inappropriate prescriptions. Improvements require policy circulation and retraining of medical doctors to reduce improve prescription practices and reduce risk of AMR.