Cargando…
Extensive antibiotic prescription rate among hospitalized patients in Uganda: but with frequent missed-dose days
OBJECTIVES: To describe the patterns of systemic antibiotic use and missed-dose days and detail the prescription, dispensing and administration of frequently used hospital-initiated antibiotics among Ugandan inpatients. METHODS: This was a prospective cohort of consented adult inpatients admitted on...
Autores principales: | , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2016
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4867101/ https://www.ncbi.nlm.nih.gov/pubmed/26945712 http://dx.doi.org/10.1093/jac/dkw025 |
_version_ | 1782432009202696192 |
---|---|
author | Kiguba, Ronald Karamagi, Charles Bird, Sheila M. |
author_facet | Kiguba, Ronald Karamagi, Charles Bird, Sheila M. |
author_sort | Kiguba, Ronald |
collection | PubMed |
description | OBJECTIVES: To describe the patterns of systemic antibiotic use and missed-dose days and detail the prescription, dispensing and administration of frequently used hospital-initiated antibiotics among Ugandan inpatients. METHODS: This was a prospective cohort of consented adult inpatients admitted on the medical and gynaecological wards of the 1790 bed Mulago National Referral Hospital. RESULTS: Overall, 79% (603/762; 95% CI: 76%–82%) of inpatients received at least one antibiotic during hospitalization while 39% (300/762; 95% CI: 36%–43%) had used at least one antibiotic in the 4 weeks pre-admission; 1985 antibiotic DDDs, half administered parenterally, were consumed in 3741 inpatient-days. Two-fifths of inpatients who received at least one of the five frequently used hospital-initiated antibiotics (ceftriaxone, metronidazole, ciprofloxacin, amoxicillin and azithromycin) missed at least one antibiotic dose-day (44%, 243/558). The per-day risk of missed antibiotic administration was greatest on day 1: ceftriaxone (36%, 143/398), metronidazole (27%, 67/245), ciprofloxacin (34%, 39/114) and all inpatients who missed at least one dose-day of prescribed amoxicillin and azithromycin. Most patients received fewer doses than were prescribed: ceftriaxone (74%, 273/371), ciprofloxacin (90%, 94/105) and metronidazole (97%, 222/230). Of prescribed doses, only 62% of ceftriaxone doses (1178/1895), 35% of ciprofloxacin doses (396/1130) and 27% of metronidazole doses (1043/3862) were administered. Seven percent (13/188) of patients on intravenous metronidazole and 6% (5/87) on intravenous ciprofloxacin switched to oral route. CONCLUSIONS: High rates of antibiotic use both pre-admission and during hospitalization were observed, with low parenteral/oral switch of hospital-initiated antibiotics. Underadministration of prescribed antibiotics was common, especially on the day of prescription, risking loss of efficacy and antibiotic resistance. |
format | Online Article Text |
id | pubmed-4867101 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-48671012016-05-16 Extensive antibiotic prescription rate among hospitalized patients in Uganda: but with frequent missed-dose days Kiguba, Ronald Karamagi, Charles Bird, Sheila M. J Antimicrob Chemother Original Research OBJECTIVES: To describe the patterns of systemic antibiotic use and missed-dose days and detail the prescription, dispensing and administration of frequently used hospital-initiated antibiotics among Ugandan inpatients. METHODS: This was a prospective cohort of consented adult inpatients admitted on the medical and gynaecological wards of the 1790 bed Mulago National Referral Hospital. RESULTS: Overall, 79% (603/762; 95% CI: 76%–82%) of inpatients received at least one antibiotic during hospitalization while 39% (300/762; 95% CI: 36%–43%) had used at least one antibiotic in the 4 weeks pre-admission; 1985 antibiotic DDDs, half administered parenterally, were consumed in 3741 inpatient-days. Two-fifths of inpatients who received at least one of the five frequently used hospital-initiated antibiotics (ceftriaxone, metronidazole, ciprofloxacin, amoxicillin and azithromycin) missed at least one antibiotic dose-day (44%, 243/558). The per-day risk of missed antibiotic administration was greatest on day 1: ceftriaxone (36%, 143/398), metronidazole (27%, 67/245), ciprofloxacin (34%, 39/114) and all inpatients who missed at least one dose-day of prescribed amoxicillin and azithromycin. Most patients received fewer doses than were prescribed: ceftriaxone (74%, 273/371), ciprofloxacin (90%, 94/105) and metronidazole (97%, 222/230). Of prescribed doses, only 62% of ceftriaxone doses (1178/1895), 35% of ciprofloxacin doses (396/1130) and 27% of metronidazole doses (1043/3862) were administered. Seven percent (13/188) of patients on intravenous metronidazole and 6% (5/87) on intravenous ciprofloxacin switched to oral route. CONCLUSIONS: High rates of antibiotic use both pre-admission and during hospitalization were observed, with low parenteral/oral switch of hospital-initiated antibiotics. Underadministration of prescribed antibiotics was common, especially on the day of prescription, risking loss of efficacy and antibiotic resistance. Oxford University Press 2016-06 2016-03-05 /pmc/articles/PMC4867101/ /pubmed/26945712 http://dx.doi.org/10.1093/jac/dkw025 Text en © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Research Kiguba, Ronald Karamagi, Charles Bird, Sheila M. Extensive antibiotic prescription rate among hospitalized patients in Uganda: but with frequent missed-dose days |
title | Extensive antibiotic prescription rate among hospitalized patients in Uganda: but with frequent missed-dose days |
title_full | Extensive antibiotic prescription rate among hospitalized patients in Uganda: but with frequent missed-dose days |
title_fullStr | Extensive antibiotic prescription rate among hospitalized patients in Uganda: but with frequent missed-dose days |
title_full_unstemmed | Extensive antibiotic prescription rate among hospitalized patients in Uganda: but with frequent missed-dose days |
title_short | Extensive antibiotic prescription rate among hospitalized patients in Uganda: but with frequent missed-dose days |
title_sort | extensive antibiotic prescription rate among hospitalized patients in uganda: but with frequent missed-dose days |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4867101/ https://www.ncbi.nlm.nih.gov/pubmed/26945712 http://dx.doi.org/10.1093/jac/dkw025 |
work_keys_str_mv | AT kigubaronald extensiveantibioticprescriptionrateamonghospitalizedpatientsinugandabutwithfrequentmisseddosedays AT karamagicharles extensiveantibioticprescriptionrateamonghospitalizedpatientsinugandabutwithfrequentmisseddosedays AT birdsheilam extensiveantibioticprescriptionrateamonghospitalizedpatientsinugandabutwithfrequentmisseddosedays |