Evaluation of Adult Outpatient Antibiotics Use at Jimma Medical Center (with Defined Daily Doses for Usage Metrics)

Figures & data

Table 1 Study Participants’ Baseline Characteristics and Other Related Information

Variables		Frequency	Percentage
Age (years)	Mean ± SD	33.07 ± 14.05
	18–35	338	68.21
	36–50	103	20.81
	51-65	25	5.04
	≥66	30	6.04
Number of antibiotics prescribed	Monotherapy	414	83.47
	Dual antibiotics	79	15.93
	Three antibiotics	3	0.60
Duration on antibiotics(days)	Mean ± SD	5.86± 3.23
	≤7	425	85.7
	>7	71	14.3
Prescriber	Medical intern	380	76.61
	Resident	84	16.94
	Senior	11	2.22
	General practitioner	21	4.23

Table 2 Primary Infectious Condition for Which Antibiotics Were Prescribed

S.No.	Disease/Disorder Type	Frequency	Percentage
1.	Urinary tract infection	120	21.58
2.	Lower respiratory tract infection	94	16.91
3.	Gastro intestinal infection (including acute gastroenteritis, PUD^£)	76	14.21
4.	Upper respiratory tract infection (AOM, pharyngitis, tonsillitis)	75	13.49
5.	Acute febrile illness	54	9.71
6.	Skin & soft tissue infection (non- occult abscess)	45	8.10
7.	Trauma (soft tissue injury, animal bite)	44	7.91
8.	Eye infection (conjunctivitis, blepharitis, etc.)	15	2.69
9.	Sexually transmitted disease/infection	6	1.10
10.	Medical prophylaxis (eg OIs in HIV)	4	0.72
11.	Unknown	23	4.14

Note: ^£Triple therapy regimen. Percentage given as per total number of infections (n = 556).

Abbreviations: HIV, human immune deficiency virus; OI, opportunistic infections; AOM, acute otitis media.

Figure 1 Comorbidity profile among study participants. Other includes retroviral infection, benign prostatic hyperplasia, irritable bowel syndrome, interstitial lung disease, and glaucoma; percentage given as per total number of patients (n = 496).

Table 3 Defined Daily Doses (DDDs) per 100 Outpatients per Day of Antibiotics Subgroups and Substances (in Accordance with the Anatomic Therapeutic Chemical (ATC) Coding System)

S.No.	ATC Code	Antibiotic Chemical Subgroup	DDD/100 Outpatients per Day	Antibiotic Type	DDD	DDD/100 Outpatients per Day
1.	J01MA	Fluoroquinolones	1.48	Ciprofloxacin	627	1.13
				Norfloxacin	196	0.35
2.	J01FA	Macrolides	0.624	Azithromycin	280	0.51
				Erythromycin	8	0.014
				Clarithromycin	53	0.10
3.	J01DB	First-generation cephalosporins	0.35	Cephalexin	197	0.35
4.	J01DD	Third generation cephalosporins	0.0146	Ceftriaxone	7	0.013
				Ceftazidime	0.9	0.0016
5.	J01XD	Imidazole derivatives	0.13	Metronidazole	69.6	0.13
6.	J01CE	Beta-lactamase sensitive penicillins	0.0314	Crystalline Penicillin	0.8	0.0014
				Benzanthine penicillin	15	0.03
7.	J01CA	Penicillins with extended spectrum	0.44	Amoxicillin	245	0.44
8.	J01CF	Beta-lactamase resistant penicillins	0.42	Cloxacillin	234	0.42
9.	J01CR	Combinations of penicillins	0.24	Amoxicillin-clavulanic acid	131	0.24
10.	J01EE	Combinations of sulfonamides and trimethoprim	0.008	Sulfamethoxazole-trimethoprim	4.5	0.008
11.	J01AA	Tetracycline	1.59	Doxycycline	883	1.59
12.	J01BA	Amphenicols	0.02	Chloramphenicol	12	0.02
	Total				2964	5.31

Table 4 Top Ten Frequently Prescribed Antibiotics in the Setting

S.No.	Antibiotics	AWaRe Class	Frequency (Percentage)^£
1.	Ciprofloxacin	Wa	122 (21.12)
2.	Amoxicillin	A	68 (11.76)
3.	Azithromycin	Wa	61 (10.55)
4.	Doxycycline	A	56 (9.69)
5.	Cephalexin	A	49 (8.48)
6.	Cloxacillin	A	48 (8.30)
7.	Norfloxacin	Wa	44 (7.61)
8.	Amoxicillin-clavulanic acid	A	37 (6.40)
9.	Metronidazole	A	37 (6.40)
10.	Benzathine penicillin	A	35 (6.06)

Note: ^£Number of patients prescribed.

Abbreviations: A, Access; Wa, Watch.

Table 5 Percentage and Total DDD of Antibiotic Consumption Based on AWaRe Classification

AWaRe Class	Specific Antibiotics	Antibiotic Prescribed (n=578)	Percentage*	Total DDD	DDD/100 Outpatients per Day
Watch group	Azithromycin	61 (10.55)	50.69	1172	2.10
	Ceftazidime	1 (0.17)
	Ceftriaxone	6 (1.04)
	Ciprofloxacin	122 (21.12)
	Clarithromycin	5 (0.86)
	Erythromycin	5 (0.86)
	Norfloxacin	44 (7.61)
Access group	Amoxicillin	68 (11.76)	49.31	1792	3.21
	Amoxicillin -clavulanic acid	37 (6.40)
	Benzathine Penicillin	35 (6.06)
	Crystalline Penicillin	1 (0.17)
	Cephalexin	49 (8.48)
	Chloramphenicol	1 (0.17)
	Cloxacillin	48 (8.30)
	Sulfamethoxazole/Trimethoprim	2 (0.35)
	Doxycycline	56 (9.69)
	Metronidazole	37 (6.40)

Note: *Calculated from the percentage prescription (293 prescription had antibiotics within “watch” group).