A point prevalence survey of antimicrobial utilisation patterns and quality indices amongst hospitals in South Africa; findings and implications

ABSTRACT

Objectives: Antimicrobial use is growing, driven mainly by rising demands in developing countries. Knowing how antimicrobials are prescribed is important. Consequently, we undertook a point prevalence survey (PPS) quantifying antimicrobial consumption among 18 public sector hospitals across South Africa.

Method: A purpose-built web-based application was used to collect PPS data.

Results: Out of 4407 adult patients surveyed, 33.6% were treated with an antimicrobial. The most frequently prescribed groups were a combination of penicillins including β-lactamase inhibitors. Amoxicillin combined with an enzyme inhibitor accounted for 21.4% total DDDs. In the medical and surgical wards, Access antimicrobials (54.1%) were mostly used, while in the ICU, Watch antimicrobials (51.5%) were mostly used. Compliance with the South African Standard Treatment Guidelines and Essential Medicines List was 90.2%; however, concerns with extended use of antimicrobials for surgical prophylaxis (73.2% of patients).

Conclusion: The web-based PPS tool was easy to use and successful in capturing PPS data since the results were comparable to other PPS studies across Africa. High use of amoxicillin combined with an enzyme inhibitor, possibly because it was among the broad-spectrum antimicrobials in the Access group. The findings will assist with future targets to improve antimicrobial prescribing among public sector hospitals in South Africa.

KEYWORDS:

• Antimicrobial consumption
• point prevalent surveys
• aware list of antimicrobials
• South Africa
• public hospitals
• quality indicators
• rational medicine use
• standard Treatment Guidelines
• surgical prophylaxis

Acknowledgments

The authors gratefully acknowledge Ms Petra Gaylard, a consultation statistician, for the statistical analysis of the data. We thank all the Departments of Health in the provinces, and the hospital management of the participating hospitals for allowing us to collect data from there. We thank the MPharm interns and the support staff for all their help with data collection.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Author contributions

N. Schellack, B.B. Godman, J.C. Meyer and M. Bennie designed the concept of the study. P. Skosana, N. Schellack and B.B. Godman orchestrated the literature review. N. Schellack, P. Skosana, and D. Kruger undertook the training sessions and co-ordinated the data collectors with the help of J.C. Meyer. P. Skosana, D. Kruger, and N. Schellack undertook the analysis of the findings and all authors contributed to the write-up of the study. All authors approved the initial and revised paper.

Additional information

Funding

The study was funded by the ENAABLERS grant and as part of a Newton Scholarship awarded to Natalie Schellack, at SMU, jointly funded by the South African Medical Research Council and UK Medical Research Council. The authors had full access to all the data and final responsibility for the decision to submit the paper for publication.