Pattern of antimicrobial usage in the adult wards of Moi Teaching and Referral Hospital, based on the world health organization-derived indicators

Abstract

Background: Worldwide, infectious diseases are an important cause of morbidity and mortality. The World Health Organization (WHO) estimates that by 2050, these diseases are anticipated to contribute to 13 million deaths worldwide annually, mainly due to antimicrobial resistance. A contributing factor to antimicrobial resistance is the irrational use of antimicrobial agents. To promote the rational use of medicines, specific indicators are used to give an overall pattern of drug usage. The WHO (2012) published a set of key indicators that can rapidly and reproducibly evaluate key antimicrobial usage patterns in a hospital setting. It is important to optimize antimicrobial use to reduce healthcare costs and alleviate rising antimicrobial resistance and associated mortality. Objective: To assess antimicrobial usage in the adult medical wards of Moi Teaching and Referral Hospital (MTRH) using selected WHO hospital, prescribing, patient care, and supplemental indicators. Method: This descriptive study was designed using the WHO (2012) prescribed tool to assess 14 specific indicators under the subsections: hospital, prescribing, patient care, and supplemental indicators. Two key informants and their offices provided information: the director of clinical services and the chief pharmacist; and from patient files. Out of 1,138 patients who were eligible (over 18 years and on treatment with an antimicrobial agent), 394 study participants were selected using systematic sampling over 3 months (February to April 2019). Data were entered into Microsoft Excel (MS Office 2010) and analyzed as means, medians, and frequencies (descriptive statistics) as detailed in the WHO tool. Results: Concerning hospital indicators, there was a lack of standard treatment guidelines for infectious diseases and an up-to-date hospital-specific formulary list. Based on the hospital inventory, only 62.6% of listed antimicrobials were available on day one of the study, while antimicrobials were out of stock for 8.7 days per month. Of the total drug expenditure, 29.4% was spent purchasing antimicrobial agents. Though the WHO recommends 100% use of generic names when prescribing, adherence was only 86.9%. Management of pneumonia complied (98%) with international guidelines. The number of antimicrobials prescribed per patient per hospitalization was between 2 and 3. The average cost, length of therapy, and hospital stay per patient per hospitalization were KShs. 5,727.97/= (USD 52.14); 8.2 days; and 12.2 days respectively. Only 67.3% of antimicrobials prescribed on the treatment records were actually administered. Seventeen (17) out of 83 samples taken for culture had microbial growth. Conclusion: There were no hospital-specific standard treatment guidelines for infectious diseases, no up-to-date formulary list, and frequent stock-outs of antimicrobial agents. There was high treatment cost and an unacceptable level of prescribed antimicrobial doses not administered to patients. Prescribing of antimicrobials was largely empiric. Recommendations: A study to determine possible causes and solutions to the gaps identified.