Publication Date
4-18-2022
Journal
BMJ Open
DOI
10.1136/bmjopen-2021-056709
PMID
35437249
PMCID
PMC9016394
PubMedCentral® Posted Date
4-18-2022
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Keywords
Adult, Anti-Bacterial Agents, Anti-Infective Agents, Emergency Service, Hospital, Female, Hospitals, Public, Humans, Liberia, Male, Practice Patterns, Physicians', Referral and Consultation, Retrospective Studies, Public Health, Epidemiology, Accident and Emergency Medicine
Abstract
OBJECTIVE: Data on antimicrobial use in low-income and middle-income countries (LMICs) remain limited. In Liberia, the absence of local data impedes surveillance and may lead to suboptimal treatment, injudicious use and resistance against antimicrobials. This study aims to examine antimicrobial prescribing patterns for patients in the emergency department (ED) of a large Liberian public hospital. Secondarily, this prescribing was compared with WHO prescribing indicators.
DESIGN: Retrospective observational study.
SETTING: An adult ED of a large public hospital in Monrovia, Liberia.
PARTICIPANTS: A total of 1082 adult patients (>18 years of age) were recorded in the ED, from 1 January to 30 June 2019.
MAIN OUTCOME MEASURES: Number, type and name of antimicrobials ordered per patient were presented as number and percentages, with comparison to known WHO prescribing indicators. Pearson χ
RESULTS: Of the total patients, 44.0% (n=476) were female and the mean age was 40.2 years (SD=17.4). An average of 2.78 (SD=2.02) medicines were prescribed per patient encounter. At least one antimicrobial was ordered for 64.5% encounters (n=713) and two or more antimicrobials for 35.7% (n=386). All antimicrobial orders in our sample used the generic name. Ceftriaxone, metronidazole and ampicillin were the most common and accounted for 61.2% (n=743) of antimicrobial prescriptions. The majority (99.9%, n=1211) of antimicrobials prescribed were from the WHO Essential Drugs List.
CONCLUSION: This study is one of the first on ED-specific antimicrobial use in LMICs. We revealed a high rate of antimicrobial prescription, regardless of patient demographic or diagnosis. While empiric antimicrobial use is justified in certain acute clinical scenarios, the high rate from this setting warrants further investigation. The results of this study underscore the importance of ED surveillance to develop targeted antimicrobial stewardship interventions and improve patient care.
Included in
Biochemical Phenomena, Metabolism, and Nutrition Commons, Emergency Medicine Commons, Public Health Commons
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