a School of Pharmacy , Faculty of Health Sciences, University of Namibia , Windhoek , Namibia.
b Department of Laboratory Medicine, Division of Clinical Pharmacology , Karolinska Institutet, Karolinska University Hospital Huddinge , Stockholm , Sweden.
Expert Rev Anti Infect Ther. 2017 Jul;15(7):713-721. doi: 10.1080/14787210.2017.1320220. Epub 2017 May 5.
Sub-optimal antibiotic prescribing remains a public health concern in Namibia. The objective was to determine the level and predictors of compliance to guidelines in the prescribing of antibiotics in acute infections at a national referral hospital in Namibia to improve future prescribing.
An analytical cross-sectional survey design. The clinical records of patients receiving care were reviewed. Prescribing practices were assessed using a self- administered questionnaire with reference to Namibia Standard Treatment Guidelines (NSTG).
The majority of prescriptions (62%) complied with the NSTGs; however, lower than national targets (95%). Most prescriptions were empiric and prescribers typically made reference to the NSTG (58%). Diagnosed infections were principally respiratory infections (58%) and penicillins were the most used antibiotics. Good concurrence between signs and symptoms with the diagnosis indicated on the prescription - OR=5.2 (95% CI: 1.4, 19.2), a diagnosis of upper respiratory tract (p=0.001), oral-dental OR=0.1(95% CI: 0.03,0.3) and urogenital infections OR=0.3(95% CI: 0.1,0.95) and the prescribing of penicillins (p=0.001) or combination antibiotics and amphenicols were independent predictors of compliance to the NSTGs. The main behaviours associated with antibiotic prescribing were patient influences, clinical state, and access to guidelines.
Compliance with NSTGs is suboptimal. Prescribing of combination antibiotics, penicillins and diagnosis of oral dental, genitourinary and ear, nose and throat infections were important predictors for NSTG compliance. There is a need to implement antibiotic indicators and stewardship programmes, and ensure access to NSTGs, to improve future antibiotic prescribing in Namibia.
在纳米比亚，抗生素的使用不规范仍然是一个公共卫生问题。本研究的目的是评估纳米比亚一家国家级转诊医院急性感染患者抗生素使用的规范程度及其影响因素，以改善未来的处方行为。
本研究采用横断面分析设计，回顾性分析了患者的临床病历。通过自行设计的调查问卷评估了处方实践，该问卷参考了纳米比亚标准治疗指南（NSTG）。
大多数处方（62%）符合 NSTG 的要求，但低于国家目标（95%）。大多数处方是经验性的，医生通常会参考 NSTG（58%）。诊断为感染的主要是呼吸道感染（58%），使用最广泛的抗生素是青霉素类。处方上的诊断与症状和体征之间存在较好的一致性，这表明 - OR=5.2（95%CI：1.4, 19.2），上呼吸道感染的诊断（p=0.001），口腔-牙科感染 OR=0.1（95%CI：0.03,0.3）和泌尿生殖系统感染 OR=0.3（95%CI：0.1,0.95），青霉素类或联合抗生素和安普霉素的处方是 NSTG 依从性的独立预测因素。与抗生素处方相关的主要行为包括患者的影响、临床状态和指南的获取。
NSTG 的依从性不高。联合使用抗生素、青霉素类药物，以及诊断口腔牙科、泌尿生殖系统和耳鼻喉感染是 NSTG 依从性的重要预测因素。需要实施抗生素指标和管理计划，并确保获得 NSTG，以改善纳米比亚未来的抗生素处方行为。
