Division of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.
Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
Hosp Pract (1995). 2022 Oct;50(4):306-317. doi: 10.1080/21548331.2022.2114251. Epub 2022 Sep 13.
Up to 90% of antimicrobials globally are prescribed and dispensed in ambulatory care. However, there are considerable gaps regarding the extent and rationale for their use especially in low- and middle-income countries such as South Africa. Point prevalent surveys (PPS) are useful to determine current prescribing patterns, identify targets for quality improvement and evaluate the effectiveness of antimicrobial stewardship programmes (ASPs) within institutions. Consequently, the objective of this study was to undertake a PPS within community healthcare centers (CHCs) in South Africa given their importance to the public healthcare system. The findings will be used to provide guidance on future interventions to improve antimicrobial use in South Africa and wider.
A PPS of antimicrobial consumption was undertaken among patients attending 18 CHCs in South Africa. A web-based application was used to record the utilization data, with utilization assessed against World Health Organization (WHO) and South African guidelines.
The overall prevalence of antimicrobial use amongst patients attending the CHCs was 21.5% (420 of 1958 patients). This included one or more antimicrobials per patient. The most frequently prescribed antimicrobials were amoxicillin (32.9%), isoniazide (11.3%) and a combination of rifampicin, isoniazid, pyrazinamide and ethambutol (Rifafour®) (10.5%), with the majority from the WHO Access list of antibiotics. There was high adherence to guidelines (93.4%). The most common indication for antibiotics were ear, nose and throat infections (22.8%), with no culture results recorded in patients' files.
It's encouraging to see high adherence to South African guidelines when antimicrobials were prescribed, with the majority taken from the WHO Access list. However, there were concerns with appreciable prescribing of antimicrobials for upper respiratory tract infections that are essentially viral in origin, and a lack of microbiological testing. The establishment of ASPs can help address identified concerns through designing and implementing appropriate interventions.
全球多达 90%的抗菌药物在门诊护理中被开具和配药。然而，在南非等低收入和中等收入国家，抗菌药物使用的范围和理由存在相当大的差距。点流行率调查（PPS）可用于确定当前的处方模式，确定质量改进的目标，并评估医疗机构内抗菌药物管理计划（ASP）的效果。因此，本研究的目的是在南非的社区医疗中心（CHC）中进行 PPS，因为它们对公共医疗体系很重要。调查结果将用于指导未来的干预措施，以改善南非和更广泛地区的抗菌药物使用。
在南非的 18 个 CHC 中，对就诊患者进行了抗菌药物消耗的 PPS。使用基于网络的应用程序记录利用数据，根据世界卫生组织（WHO）和南非指南评估利用情况。
在 CHC 就诊患者中，抗菌药物使用的总体流行率为 21.5%（1958 名患者中有 420 名）。这包括每位患者使用一种或多种抗菌药物。最常开的抗菌药物是阿莫西林（32.9%）、异烟肼（11.3%）和利福平、异烟肼、吡嗪酰胺和乙胺丁醇的组合（Rifafour®）（10.5%），大多数来自 WHO 抗生素获取清单。指南的遵循率很高（93.4%）。抗生素最常见的适应证是耳、鼻和喉感染（22.8%），但患者档案中没有记录培养结果。
当开具抗菌药物时，南非指南的高遵循率令人鼓舞，大多数抗菌药物来自 WHO 抗生素获取清单。然而，对于本质上是病毒引起的上呼吸道感染，相当数量的抗菌药物的处方值得关注，而且缺乏微生物学检测。通过设计和实施适当的干预措施，抗菌药物管理计划的建立可以帮助解决已确定的问题。
