An antibiotic audit of the surgical department at a rural hospital in Western Kenya

INTRODUCTION: Antibiotics are one of the most commonly prescribed medications in hospitalized patients, with up to half of prescriptions being irrational. This study aimed to assess the quality of antibiotic use among surgical inpatients at our institution. METHODS: A one year (January 1-December 31, 2015) retrospective chart review on antibiotic use for patients admitted to the surgical department at AIC Litein Hospital, a faith based non-governmental health institution in Western Kenya, was conducted. Data were collected from medical and nursing patient charts with a standardized questionnaire. The criteria applied to assess inappropriate antibiotic use focused on the choice, duration and indication of the antibiotics prescribed. RESULTS: A total of 394 cases were evaluated, with a mean age of 44.8 years and a mean duration of hospitalization of 7.2 days. Antibiotics were initiated either for prophylaxis (205, 56.3%) or treatment (159, 43.7%) for a mean duration of 6 days (range 1-37). The predominant route of administration was intravenous (332, 91.2%). Most antibiotics started at admission were continued till discharge and the duration of antibiotics was indicated in only 11% of the treatment sheets. At discharge, 321 (81.4%) cases had antibiotics prescribed for a mean duration of 5.7 days (range 1-60). Inappropriate prescriptions were noted in 45.4% of prophylactic antibiotics, 33.4% treatment antibiotics and 52.6% of discharge antibiotics. The most common reason for inappropriate antibiotic use during hospitalization was inappropriate duration (45.9%). CONCLUSION: Proper documentation, daily antibiotic review and preparation of a local antibiotic policy guideline could help improve the appropriate use of antibiotics.