Prescribing Pattern of Antibiotics Using WHO Prescribing Indicators Among Inpatients in Ethiopia: A Need for Antibiotic Stewardship Program

Figures & data

Table 1 Socio-Demographic Characteristics of Patients Admitted to AKU-CSH, Aksum, Northern Ethiopia, 2020

Variable	Category	Included Wards (N=822)			Total Frequency (%)	Proportion (95% CI)
		Surgical (n=384)	Medical (n=313)	Gyn/Obs (n=125)
Gender	Female	202 (40.6)	171 (34.3)	125 (25.1)	498 (60.6)	50.2–71.3%
	Male	182 (56.2)	142 (43.8)	–	324 (39.4)	31.3–47.2%
Age (years)	Mean±SD	31±11.1	36±10.2	25±9.3	34.2±8.31
Marital status	Never married	101 (50.8)	98 (49.2)	–	199 (24.2)	23.1–25.1
	Ever married	283 (45.4)	215 (34.5)	125 (20.1)	623 (75.8)	73.1–78.2
Residence	Rural	276 (48.3)	232 (40.6)	64 (11.2)	572 (69.6)	67.2–72.1
	Urban	108 (43.2)	81 (32.4)	61 (24.4)	250 (30.4)	28.2–31.8

Abbreviations: AKU-CSH, Aksum University College of Health Sciences and Comprehensive Specialized Hospital; Gyn/Obs, gynecology/obstetrics.

Table 2 WHO Prescribing Indicators of Antibiotics Among Patients Admitted to AKU-CSH, Aksum, Northern Ethiopia, 2020

Prescribing Indicator	Selected Wards, n (%) [N=1571]			Total, n=822 n (%), mean±SD	Proportion (95% CI)	Ideal Value^Citation1,Citation6,Citation27
	Surgical	Medical	Gyn/Obs
Percentage of patients admitted with at least one antibiotic	384 (46.7)	313 (38.1)	125 (15.2)	822 (52.3)	48.2–54.4	20–26
Average number of antibiotics prescribed per patient	974 (2.54)	491 (1.57)	188 (1.53)	2.01±1.9	–	1.6–1.8
Percentage of antibiotics prescribed from national FL/EML	974 (100)	491 (100)	188 (100)	1653 (100)	–	100
Percentage of antibiotics prescribed by generic name	969 (99.5)	461 (93.9)	183 (97.3)	1613 (97.6)	94–99.1	100
Percentage of antibiotics prescribed in injection form	879 (53.2)	360 (21.8)	163 (9.9)	1402 (84.8)	82.5–87.1	13.4–24.1
Percentage of antibiotics prescribed in oral form	95 (5.7)	131 (7.9)	25 (1.5)	251 (15.2)	12.8–17.1
Average duration of days antibiotic prescribed in the hospital stay	4.2	6.8	1.5	4.2±2.3	–	–
Percentage of patients who received antibiotics for therapeutic purpose	76 (19.8)	301 (96.2)	35 (28.0)	412 (50.1)	58.7–64.6	–
Percentage of patients who received antibiotics for prophylactic purpose	283 (73.7)	7 (2.2)	75 (60.0)	365 (44.4)	29.5–34.3	–
Percentage of patients who received antibiotics for unknown purpose	25 (6.5)	5 (1.6)	15 (12.0)	45 (5.5)	4.4–7.1	0
Percentage of patients who received antibiotics for empiric therapy	101 (100)	306 (100)	50 (100)	457 (100)	–	–

Abbreviations: AKU-CSH, Aksum University, College of Health Sciences and Comprehensive Specialized Hospital; Gyn/Obs, gynecology and obstetrics; FL/EML, Formulary List/Essential Medicine List.

Table 3 Hospital and Patient Indicators for Prescribing Antibiotics for Patients Admitted to AKU-CSH, Aksum, Northern Ethiopia, 2020

Hospital Indicator	Results	Recommended
Existence of DTC	1	1
Existence of copy of national STGs for tertiary hospitals	0	1
Existence of institutional STGs/clinical guideline for infectious diseases	0	1
Existence of a copy of national FL/EML	1	1
Existence of institutional FL/EML	0	1
Availability of a set of key antibiotics in the hospital in the study period	65.2%	100%
Average number of days that a set of key antibiotics is out of stock/month	3.8	0
Number of sensitivity tests performed for the prescribed antibiotics	0	Exist

Note: Yes=1, No=0.

Abbreviations: DTC, Drug and Therapeutics Committee; STG, Standard Treatment Guideline; FL/EML, Formulary List/Essential Medicine List.

Figure 1 Number of days prescribed antibiotics for patients admitted to selected wards of AKU-CSH, Aksum, northern Ethiopia, 2020.

Table 4 Distribution of Antibiotics Prescribed for Patients Admitted to Selected Wards of AKU-CSH, Aksum, Northern Ethiopia, 2020

Antibiotics	Involved Wards, n (%)			Total, n (%)	Proportion (95% CI)
	Surgical (n=384)	Medical (n=313)	Gyn/Obs (n=125)
Ampicillin injection	5 (0.5)	0 (0.0)	87 (46.3)	92 (5.6)	3.8–6.9
Amoxicillin–clavulanic acid tablet	85 (8.7)	72 (14.7)	5 (2.7)	162 (9.8)	7.4–11.2
Amoxicillin capsule	39 (4.0)	101 (20.6)	11 (5.9)	151 (9.1)	8.1–9.9
Crystalline penicillin injection	21 (2.2)	0 (0.0)	1 (0.5)	22 (1.3)	1.1–1.8
Cloxacillin injection/capsule	12 (1.2)	0 (0.0)	2 (1.1)	14 (0.8)	0.2–1.1
Ceftriaxone injection	255 (26.2)	79 (16.1)	71 (37.8)	405 (24.5)	22.7–26.3
Cephalexin capsule	84 (8.6)	2 (0.4)	9 (4.8)	95 (5.7)	4.5–6.6
Ceftazidime injection	14 (1.4)	2 (0.4)	0 (0.0)	16 (1.0)	0.6–1.2
Ciprofloxacin injection	8 (0.8)	0 (0.0)	0 (0.0)	8 (0.5)	0.1–0.9
Cefepime injection	65 (6.7)	25 (5.1)	0 (0.0)	90 (5.4)	4.1–6.3
Vancomycin injection	202 (20.7)	17 (3.5)	0 (0.0)	219 (13.2)	12.1–14.3
Gentamycin injection	6 (0.6)	0 (0.0)	2 (1.1)	8 (0.5)	0.1–0.9
Metronidazole injection	126 (12.9)	31 (6.3)	0 (0.0)	157 (9.5)	8.3–10.1
Azithromycin capsule	52 (5.3)	162 (33)	0 (0.0)	214 (12.9)	11.6–13.8
Total	974 (58.9)	491 (29.7)	188 (11.4)	1653 (100)
Combination
Metronidazole + ciprofloxacin	5 (1.7)	0 (0.0)	0 (0.0)	5 (1.2)	0.9–1.6
Azithromycin + ceftriaxone	32 (11.0)	81 (63.3)	0 (0.0)	113 (26.8)	24.1–27.9
Ceftriaxone + vancomycin	130 (44.7)	2 (1.6)	0 (0.0)	132 (31.4)	28.3–32.8
Metronidazole + vancomycin	55 (18.9)	15 (11.7)	0 (0.0)	70 (16.6)	15.1–17.3
Ciprofloxacin + vancomycin	3 (1.0)	0 (0.0)	0 (0.0)	3 (0.7)	0.2–0.9
Ceftazidime + vancomycin	14 (4.8)	2 (1.6)	0 (0.0)	16 (3.8)	2.2–4.3
Ceftriaxone + gentamycin	1 (0.3)	0 (0.0)	1 (0.5)	2 (0.5)	0.1–0.9
Ampicillin + gentamycin	5 (1.7)	0 (0.0)	1 (0.5)	6 (1.4)	1.1–1.9
Ceftriaxone + metronidazole	26 (8.9)	16 (12.5)	0 (0.0)	42 (10.0)	8.8–11.7
Azithromycin + amoxicillin–clavulanic acid	20 (6.9)	12 (9.4)	0 (0.0)	32 (7.6)	6.1–8.3

Abbreviations: AKU-CSH, Aksum University College of Health Sciences and Comprehensive Specialized Hospital; Gyn/Obs, gynecology/obstetrics.

Figure 2 Numbers of prescribed antibiotics per prescription for patients admitted to selected wards of AKU-CSH, Aksum, northern Ethiopia, 2020.

WHO. How to Investigate Antimicrobial Use in Hospitals: Selected Indicators. World Health Organization; 2012.

 Google Scholar

Atif M, Azeem M, Saqib A, Scahill S. Investigation of antimicrobial use at a tertiary care hospital in Southern Punjab, Pakistan using WHO methodology. Antimicrob Resist Infect Control. 2017;6(1):41. doi:10.1186/s13756-017-0199-728465825

 PubMed Web of Science ®Google Scholar

Amaha ND, Berhe YH, Kaushik A. Assessment of inpatient antibiotic use in Halibet National Referral Hospital using WHO indicators: a retrospective study. BMC Res Notes. 2018;11:904. doi:10.1186/s13104-018-4000-730563558

 PubMedGoogle Scholar