Appropriate Use of Ceftriaxone in Sub-Saharan Africa: A Systematic Review

Abstract

Introduction

Ceftriaxone is the most frequently used antibiotic for the treatment of various bacterial infections in hospitalized and ambulatory patients. Despite this, inappropriate ceftriaxone use is common.

Objective

The aim of this review is to assess the appropriate use of ceftriaxone in sub-Saharan African countries.

Methods

A systematic search was done on PubMed, EMBASE, Cochrane Libraries and Google Scholar for papers published addressing the prescribing pattern and use of ceftriaxone in sub-Saharan Africa. The findings were reported in medians and quartiles.

Results

A total of 15 articles met the inclusion criteria. Pneumonia and sepsis were the most frequently diagnosed infections in the included studies. The overall median prevalence of appropriate ceftriaxone use is 39.2% (IQR: 29.9–60.9), showing that most of the included studies reported a higher prevalence of inappropriate ceftriaxone use. Although there are a higher number of patients with inappropriate use of ceftriaxone, a relatively higher number of patients got appropriate daily dose (79.8%, IQR: 45.7–89.4) of ceftriaxone than appropriate duration of ceftriaxone (55%, IQR: 52.2–80).

Conclusion

The review revealed that three in five patients with ceftriaxone got inappropriate ceftriaxone’s dose, frequency or duration. A relatively higher number of patients got appropriate daily dose of ceftriaxone. On the other hand, approximately more than half of the patients got inappropriate duration, too short or too long, of ceftriaxone. Hence, prescribers are recommended to adhere to their country-specific treatment guideline. Moreover, it is highly recommended to either commence or strengthen antimicrobial stewardship program effectively in their healthcare settings.

Keywords:

• ceftriaxone
• ceftriaxone use evaluation
• prescribing pattern
• sub-Saharan Africa

Acknowledgments

We would like to acknowledge the Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia.

Abbreviations

IQR, Interquartile Range; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; SAP, Surgical Antibiotic Prophylaxis; SSA, Sub-Saharan Africa; SSI, Surgical Site Infection.

Data Sharing Statement

The datasets used during the current study are available from the corresponding author on a reasonable request.

Author Contributions

All authors made a significant contribution to the work reported, in the conception, study design, execution, acquisition of data, analysis, and interpretation; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted, and agree to be accountable for all aspects of the work.

Disclosure

The authors declared that they have no conflicts of interest in this work.