A national, multicentre web-based point prevalence survey of antimicrobial use in community healthcare centres across South Africa and the implications

Figures & data

Table 1. Overall antimicrobial consumption by patient demographics.

	Number of prescriptions with at least one antimicrobial (n = 486)	Percentage (%)
Age
Neonate (0–28 days)	1	0.2
Infant (1–11 months)	10	2.1
Child (1–12 years)	55	11.3
Adolescent (13–17 years)	15	3.1
Adult (18–35 years)	175	36.0
Adult (36–55 years)	155	31.9
Adult (≥56 years)	75	15.4
Gender
Female	274	56.4
Male	212	43.6

Table 2. Indications along with the antimicrobials prescribed for treatment.

Indication	Antimicrobial prescribed	ATC class	Number of times antimicrobials prescribed	Percentage of the total within each indication
Asymptomatic bacteriuria (Presence of bacteria in urine without symptoms)			3
	Amoxicillin	J01CA04	1	33.3%
	Azithromycin	J01FA10	1	33.3%
	Ciprofloxacin	J01MA02	1	33.3%
Bone and joint infections (e.g., septic arthritis, prosthetic joint infections, osteomyelitis)			11
	Amoxicillin	J01CA04	9	82%
	Amoxicillin and beta-lactamase inhibitor	J01CR02	1	9%
	Flucloxacillin	J01CF05	1	9%
Acute bronchitis or exacerbations of chronic bronchitis			8
	Amoxicillin	J01CA04	8	100%
Infections of the central nervous system			1
	Amoxicillin	J01CA04	1	100%
Symptomatic lower urinary tract infection, e.g., cystitis			24
	Amoxicillin	J01CA04	2	8%
	Amoxicillin and beta-lactamase inhibitor	J01CR02	1	4%
	Azithromycin	J01FA10	7	29%
	Ciprofloxacin	J01MA02	6	25%
	Cloxacillin	J01CF02	1	4%
	Doxycycline	J01AA02	1	4%
	Metronidazole (oral/rectal)	P01AB01	5	21%
	Metronidazole (parenteral)	J01XD01	1	4%
Upper respiratory tract Infections – ear, nose, throat, larynx, mouth excluding bronchus			79
	Amoxicillin	J01CA04	54	68%
	Amoxicillin and beta-lactamase inhibitor	J01CR02	5	6%
	Azithromycin	J01FA10	8	10%
	Ceftriaxone	J01DD04	2	3%
	Metronidazole (oral/rectal)	P01AB01	4	5%
	Nystatin	A07AA02	1	1%
	Phenoxymethylpenicillin	J01CE02	5	6%
Extra pulmonary tuberculosis			14
	Isoniazid	J04AC01	1	7%
	Pyrazinamide	J04AK01	1	7%
	(Rifampicin, isoniazid, pyrazinamide and ethambutol) Rifafour®	J04AM06	10	71%
	Rifampicin	J04AB02	2	14%
Eye infections e.g., endophthalmitis			5
	Amoxicillin	J01CA04	4	80%
	Amoxicillin and beta-lactamase inhibitor	J01CR02	1	20%
Gastrointestinal infections, e.g., salmonellosis, bacterial-associated diarrhea			16
	Amoxicillin	J01CA04	5	31%
	Amoxicillin and beta-lactamase inhibitor	J01CR02	1	6%
	Ceftriaxone	J01DD04	2	13%
	Ciprofloxacin	J01MA02	1	6%
	Metronidazole (oral/rectal)	P01AB01	3	19%
	Phenoxymethylpenicillin	J01CE02	1	6%
	Sulfamethoxazole and trimethoprim	J01EE01	2	13%
	Sulfamethoxazole and trimethoprim	J01EE02	1	6%
Prostatitis, epididymo-orchitis, and sexually transmitted diseases in men			10
	Amoxicillin	J01CA04	1	10%
	Azithromycin	J01FA10	3	30%
	Ciprofloxacin	J01MA02	5	50%
	Metronidazole (oral/rectal)	P01AB01	1	10%
Malnutrition			1
	Amoxicillin and beta-lactamase inhibitor	J01CR02	1	100%
Not applicable for antimicrobial use other than treatment			50
	Amoxicillin	J01CA04	28	56%
	Amoxicillin and beta-lactamase inhibitor	J01CR02	5	10%
	Ampicillin	J01CA01	1	2%
	Azithromycin	J01FA10	6	12%
	Ceftriaxone	J01DD04	1	2%
	Ciprofloxacin	J01MA02	3	6%
	Cloxacillin	J01CF02	2	4%
	Metronidazole (oral/rectal)	P01AB01	2	4%
	Phenoxymethylpenicillin	J01CE02	1	2%
	Sulfamethoxazole and trimethoprim	J01EE01	1	2%
Obstetric or gynecological infections, e.g., STDs in women, abortion related and post-partum sepsis			23
	Amoxicillin	J01CA04	1	4%
	Azithromycin	J01FA10	4	17%
	Ceftriaxone	J01DD04	2	9%
	Ciprofloxacin	J01MA02	9	39%
	Metronidazole (oral/rectal)	P01AB01	6	26%
	Sulfamethoxazole and trimethoprim	J01EE01	1	4%
Pneumonia (other than TB)			16
	Amoxicillin	J01CA04	9	56%
	Amoxicillin and beta-lactamase inhibitor	J01CR02	3	19%
	Ciprofloxacin	J01MA02	1	6%
	Sulfamethoxazole and trimethoprim	J01EE01	3	19%
Symptomatic upper urinary tract infection (ureter and kidney) e.g., pyelonephritis			3
	Amoxicillin and beta-lactamase inhibitor	J01CR02	1	33%
	Azithromycin	J01FA10	1	33%
	Cefalexin	J01DB01	1	33%
Systemic inflammatory response syndrome with no clear anatomical site of infection.			1
	Cloxacillin	J01CF02	1	100%
Soft tissue infections, e.g., cellulitis, wound and deep soft tissue – not involving bone			25
	Amoxicillin	J01CA04	8	32%
	Amoxicillin and beta-lactamase inhibitor	J01CR02	4	16%
	Azithromycin	J01FA10	1	4%
	Cefalexin	J01DB01	1	4%
	Cloxacillin	J01CF02	1	4%
	Flucloxacillin	J01CF05	7	28%
	Metronidazole (oral/rectal)	P01AB01	3	12%
Pulmonary tuberculosis			41
	(Rifampicin, isoniazid, pyrazinamide and ethambutol) Rifafour®	J04AM06	41	100%
Completely undefined; site with no systemic inflammation			15
	Amoxicillin	J01CA04	12	80%
	Metronidazole (oral/rectal)	P01AB01	2	13%
	Sulfamethoxazole and trimethoprim	J01EE01	1	7%
Indication not in patient file			24
Prophylaxis			116
Total prescribed			486

Figure 1. 3^rd level ATC Classification of antimicrobials by age groups.

NB: Categorization of antimicrobial use among the pediatric population was combined, y = years

Table 3. Antimicrobials prescribed according to the top five antimicrobial classes.

ATC level 3	Antimicrobial	ATC code	Number of times antimicrobials are prescribed	Percentage of the total (486)
J01C: Beta-lactam antibacterials	Amoxicillin	J01CA04	160	32.9%
	Amoxicillin and beta lactamase inhibitor	J01CR02	32	6.6%
	Flucloxacillin	J01CF05	14	2.9%
	Cloxacillin	J01CF02	7	1.4%
	Ampicillin	J01CA01	1	0.2%
J01E: Sulfonamides and trimethoprim	Sulfamethoxazole and trimethoprim	J01EE01	43	8.9%
J01F: Macrolides, lincosamides and streptogramins	Azithromycin	J01FA10	37	7.6%
J04A: Drugs for treatment of tuberculosis	Isoniazid	J04AC01	55	11.3%
	Rifampicin, isoniazid, pyrazinamide and ethambutol	J04AM06	51	10.5%
	Rifampicin	J04AB02	2	0.4%
	Pyrazinamide	J04AK01	1	0.2%
P01A: Agents against amoebiasis and other protozoal diseases	Metronidazole (oral/rectal)	P01AB01	32	6.6%
Other classes			51	10.5%

Table 4. Quality indicator summary.

	Number of antimicrobials (n = 486)	Percentage of the total (%)
Route of administration
Oral	474	97.5
Intravenous	9	1.9
Intramuscular	3	0.6
AWaRe classification
Access	302	62.1
Watch	73	15.0
Reserve	0	0.0
Unclassified	111	22.8
Purpose for use
Prophylaxis	116	23.9
Treatment	370	76.1
Item prescribed by
Medical Officer	295	60.7
Nurse	176	36.2
Specialist	15	3.1
Item prescribed from South African EML-STG
Yes	454	93.4
No	32	6.6
Item written by generic name (INN)
Yes	338	69.5
No	148	30.5

NB: Unclassified means no classification currently in the WHO AWaRe list; EML-STG = Essential Medicines List and Standard Treatment Guidelines

Data Availability Statement

Additional data is available on reasonable request.