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Antibiotic Use Among Hospitalized Patients in Africa: A Systematic Review of Point Prevalence Studies

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submitted on 2024-01-16, 06:18 and posted on 2024-01-17, 05:35 authored by Usman Abubakar, Muhammad Salman

Background

There is paucity of data describing the rate and quality indices of antibiotics used among hospitalized patients at continental level in Africa. This systematic review evaluated the pooled prevalence, indications, and types of antibiotics used in hospitals across Africa.

Methods

Three electronic databases, PubMed, Scopus, and African Journals Online (AJOL), were searched using search terms. Point prevalence studies of antibiotic use in inpatient settings published in English language from January 2010 to November 2022 were considered for selection. Additional articles were identified by checking the reference list of selected articles.

Results

Of the 7254 articles identified from the databases, 28 eligible articles involving 28 studies were selected. Most of the studies were from Nigeria (n = 9), Ghana (n = 6), and Kenya (n = 4). Overall, the prevalence of antibiotic use among hospitalized patients ranged from 27.6 to 83.5% with higher prevalence in West Africa (51.4–83.5%) and North Africa (79.1%) compared to East Africa (27.6–73.7%) and South Africa (33.6–49.7%). The ICU (64.4–100%; n = 9 studies) and the pediatric medical ward (10.6–94.6%; n = 13 studies) had the highest prevalence of antibiotic use. Community-acquired infections (27.7–61.0%; n = 19 studies) and surgical antibiotic prophylaxis (SAP) (14.6–45.3%; n = 17 studies) were the most common indications for antibiotic use. The duration of SAP was more than 1 day in 66.7 to 100% of the cases. The most commonly prescribed antibiotics included ceftriaxone (7.4–51.7%; n = 14 studies), metronidazole (14.6–44.8%; n = 12 studies), gentamicin (n = 8 studies; range: 6.6–22.3%), and ampicillin (n = 6 studies; range: 6.0–29.2%). The access, watch, and reserved group of antibiotics accounted for 46.3–97.9%, 1.8–53.5%, and 0.0–5.0% of antibiotic prescriptions, respectively. The documentation of the reason for antibiotic prescription and date for stop/review ranged from 37.3 to 100% and 19.6 to 100%, respectively.

Conclusion

The point prevalence of antibiotic use among hospitalized patients in Africa is relatively high and varied between the regions in the continent. The prevalence was higher in the ICU and pediatric medical ward compared to the other wards. Antibiotics were most commonly prescribed for community-acquired infections and for SAP with ceftriaxone, metronidazole, and gentamicin being the most common antibiotics prescribed. Antibiotic stewardship is recommended to address excessive use of SAP and to reduce high rate of antibiotic prescribing in the ICU and pediatric ward.

Other Information

Published in: Journal of Racial and Ethnic Health Disparities
License: https://creativecommons.org/licenses/by/4.0
See article on publisher's website: https://dx.doi.org/10.1007/s40615-023-01610-9

Funding

Open Access funding provided by the Qatar National Library.

History

Language

  • English

Publisher

Springer Nature

Publication Year

  • 2023

License statement

This Item is licensed under the Creative Commons Attribution 4.0 International License.

Institution affiliated with

  • Qatar University
  • Qatar University Health - QU
  • College of Pharmacy - QU HEALTH

Methodology

Three electronic databases, PubMed, Scopus, and African Journals Online (AJOL), were searched using search terms. Point prevalence studies of antibiotic use in inpatient settings published in English language from January 2010 to November 2022 were considered for selection. Additional articles were identified by checking the reference list of selected articles.

Geographic coverage

Africa