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

Figures & data

Figure 1 Article screening process.

Table 1 Study Quality Assessment Using Newcastle-Ottawa Quality Assessment Scale

S.n	Author Yr (Ref)	Methodological Quality (4pts)	Comparability (2)	Outcome Measurement and Analysis (2)	Total (8)
1	Abebe FA et al. 2012^Citation24	3	1	1.5	5.5
2	Afriyie DK et al. 2017^Citation22	3	1	1.5	5.5
3	Ayele AA et al. 2018^Citation16	3.5	1	1.5	6
4	Ayinalem GA et al. 2013^Citation25	3	1	1.5	5.5
5	Bantie et al. 2014^Citation26	3	1	1.5	5.5
6	Berhe YH et al. 2019^Citation15	3	1.5	1.5	6
7	Eulambius M et al. 2019^Citation27	3	0.5	2	5.5
8	Manirakiza L et al. 2019^Citation28	3.5	0.5	2	6
9	Sasi P et al. 2019^Citation29	3.5	2	2	7.5
10	Hussien LA. 2019^Citation23	3.5	1.5	2	7
11	Negese S et al. 2017^Citation30	3.5	1.5	2	7
12	Shimels T et al. 2015^Citation31	3.5	1	1.5	6
13	Sonda TB et al. 2019^Citation14	3.5	1	1.5	6
14	Geresu G et al. 2018^Citation32	2.5	1	1.5	5
15	Muhammed OS et al. 2020^Citation33	3	1	1.5	5.5

Table 2 General Characteristics of the Included Studies

S.n	Author Yr (Ref)	Study Country	Study Setting (Private or Public)	Sample Size (n)	Appropriate Prescribing Practice (%)	Common Indications
						Pneumonia/ RTI (%)	Sepsis (%)	Meningitis (%)	UTI (%)	Prophylaxis (%)	No Indication (%)	Others^a (%)
1	Abebe FA et al. 2012^Citation24	Ethiopia	Public	296	35.8	21.4	19.4	4.9	14.5	33	NR	6.8
2	Afriyie DK et al. 2017^Citation22	Ghana	Public	251	93	5.6	9.6	19.9	11.6	2.4	4.4 *	46.5
3	Ayele AA et al. 2018^Citation16	Ethiopia	Public	390	19.8	29.3	1.5	24.1	8.5	16.4	3.1	17.1
4	Ayinalem GA et al. 2013^Citation25	Ethiopia	Public	316	54	36.4	4.7	30.4	20.9	0	0	7.6
5	Bantie et al. 2014^Citation26	Ethiopia	Public	264	61	27.7	5.7	12.1	3.8	25	8.71	7.9
6	Berhe YH et al. 2019^Citation15	Eritrea	Public	109	27.5	36.7	21.8	2.8	5.5	0	2.3	30.9
7	Eulambius M et al. 2019^Citation27	Tanzania	Public and Private	600	33.9	13.4	9.2	2.5	7.2	55	NR	12.5
8	Manirakiza L et al. 2019^Citation28	Uganda	Public	100	53	19	19	22	9	2	1	28
9	Sasi P et al. 2019^Citation29	Tanzania	Public	360	30	29.4	0	7.5	1.7	0	0	60
10	Hussien LA. 2019^Citation23	Sudan	Public	90	6.7	3.3	31	2.2	31	0	NR	32.4
11	Negese S et al. 2017^Citation30	Ethiopia	Public	127	29.9	22	12.6	7.1	3.9	15	NR	39.4
12	Shimels T et al. 2015^Citation31	Ethiopia	Public and Private	477	61.7	32.7	13.1	14.7	6.1	7.7	NR	25.8
13	Sonda TB et al. 2019^Citation14	Tanzania	Public	322	48.9	11.2	8.7	1.6	0	13.6	6.9	58
14	Geresu G et al. 2018^Citation32	Ethiopia	Public	403	39.2	46.2	2.2	21.8	15.9	0	NR	13.8
15	Muhammed OS et al. 2020^Citation33	Ethiopia	Public	601	60.6	24.8	2.7	3.2	5	39.8	NR	24.5

Notes: *Indication for suspecting of malaria with bacterial infection ^aOthers include; typhoid fever, acute febrile illness, cellulitis, sexually transmitted diseases, acute gastroenteritis, tuberculosis, PUD, cough, osteomyelitis and others.

Abbreviations: NR, not reported; ref, reference; LRTI, Lower respiratory tract infection; UTI, Urinary tract infection.

Table 3 Pattern of Ceftriaxone Use in the Included Studies

S.n	Author Yr (Ref)	% of Patients Who Used the Specified Dose of Ceftriaxone Daily				% of Patients with Appropriate Daily Ceftriaxone Dose (%)	% of Patients Who Used the Specified Duration of Ceftriaxone					% of Patients with Appropriate Ceftriaxone Duration (%)
		< 2gm	2gm	3gm	4gm		Stat	1 d	2–7 d	8–14 d	>14 d
1	Abebe FA et al. 2012^Citation24	16.6	79.4	5.3	3.7	79.4	1.69	10.47	51.69	28.04	8.11	51.7
2	Afriyie DK et al. 2017^Citation22	57.6	39.4	1.5	1.5	100	12	43.4	48.6	0	0	85.7
3	Ayele AA et al. 2018^Citation16	1.5	76.9	1.5	20	80.1	0	5.1	25.9	37.2	31.8	53
4	Ayinalem GA et al. 2013^Citation25	9.5	63.6	0.9	25.9	77.4	8.5	13.3	76.6	2.8	1.3	52.6
5	Bantie et al. 2014^Citation26	–	–	–	–	86	–	–	–	–	–	82
6	Berhe YH et al. 2019^Citation15	5.5	94.5	0	0	50.5	11.4	20	28.4	35.5	4.7	26.6
7	Eulambius M et al. 2019^Citation27	19	74	0	1	18	0	7	88	5	0	78
8	Manirakiza L et al. 2019^Citation28	72.9	22.9	6	3.6	31.2	15.6	50	32.2	2.2	0	55
9	Sasi P et al. 2019^Citation29	87.7	11.1	0.5	0.5	0	0	15.6	33.9	48.3	2.2
10	Hussien LA. 2019^Citation23	23.6	71.7	0.8	3.9	94.2	4.7	5.5	70.1	17.3	2.4	71.7
11	Negese S et al. 2017^Citation30	0	73.5	0	26.5	87.8	0	1.2	83.9	13.6	1.2	18
12	Shimels T et al. 2015^Citation31	0	78.6	18.6	2.8	95.8	5.1	14.5	68.1	9.3	3	91.6

Note: NB, some of the included studies did not report information on the appropriateness of daily dose, frequency and duration of ceftriaxone.

Abbreviations: Stat, the first single dose; ref, reference.

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