Allwell-Brown Gbemisola, Namugambe Juliet Sanyu, Ssanyu Jacquellyn Nambi, Johansson Emily White, Hussain-Alkhateeb Laith, Strömdahl Susanne, Mårtensson Andreas, Kitutu Freddy Eric
Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, SE-751 85 Uppsala, Sweden.
Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda.
JAC Antimicrob Resist. 2022 Sep 5;4(5):dlac091. doi: 10.1093/jacamr/dlac091. eCollection 2022 Oct.
To describe patterns and contextual determinants of antibiotic prescribing for febrile under-five outpatients at primary and secondary healthcare facilities across Bugisu, Eastern Uganda.
We surveyed 37 public and private-not-for-profit healthcare facilities and conducted a retrospective review of antimicrobial prescribing patterns among febrile under-five outpatients (with a focus on antibiotics) in 2019-20, based on outpatient registers. Multilevel logistic regression analysis was used to identify determinants of antibiotic prescribing at patient- and healthcare facility-levels.
Antibiotics were prescribed for 62.2% of 3471 febrile under-five outpatients. There were a total of 2478 antibiotic prescriptions of 22 antibiotic types: amoxicillin (52.2%), co-trimoxazole (14.7%), metronidazole (6.9%), gentamicin (5.7%), ceftriaxone (5.3%), ampicillin/cloxacillin (3.6%), penicillin (3.1%), and others (8.6%). Acute upper respiratory tract infection (AURTI) was the commonest single indication for antibiotic prescribing, with 76.3% of children having AURTI as their only documented diagnosis receiving antibiotic prescriptions. Only 9.2% of children aged 2-59 months with non-severe pneumonia received antibiotic prescriptions in line with national guidelines. Higher health centre levels, and private-not-for-profit ownership (adjusted OR, 4.30; 95% CI, 1.91-9.72) were significant contextual determinants of antibiotic prescribing.
We demonstrated a high antibiotic prescribing prevalence among febrile under-five outpatients in Bugisu, Eastern Uganda, including prescriptions for co-trimoxazole and ampicillin/cloxacillin (which are not indicated in the management of the common causes of under-five febrile illness in Uganda). Study findings may be linked to limited diagnostic capacity and inadequate antibiotic availability, which require prioritization in interventions aimed at improving rational antibiotic prescribing among febrile under-five outpatients.
描述乌干达东部布吉苏地区基层和二级医疗机构中五岁以下发热门诊患者抗生素处方的模式及背景决定因素。
我们调查了37家公立和非营利性医疗机构，并根据门诊登记册对2019 - 20年五岁以下发热门诊患者（重点是抗生素）的抗菌药物处方模式进行了回顾性分析。采用多水平逻辑回归分析来确定患者和医疗机构层面抗生素处方的决定因素。
在3471名五岁以下发热门诊患者中，62.2%的患者使用了抗生素。共开出2478张抗生素处方，涉及22种抗生素类型：阿莫西林（52.2%）、复方新诺明（14.7%）、甲硝唑（6.9%）、庆大霉素（5.7%）、头孢曲松（5.3%）、氨苄西林/氯唑西林（3.6%）、青霉素（3.1%）以及其他（8.6%）。急性上呼吸道感染（AURTI）是抗生素处方最常见的单一指征，76.3%仅记录有AURTI诊断的儿童接受了抗生素处方。在2至59个月患有非重症肺炎的儿童中，只有9.2%的儿童根据国家指南接受了抗生素处方。较高的卫生中心级别以及非营利性私立机构（调整后的比值比，4.30；95%置信区间，1.91 - 9.72）是抗生素处方的重要背景决定因素。
我们发现乌干达东部布吉苏地区五岁以下发热门诊患者的抗生素处方率很高，包括复方新诺明和氨苄西林/氯唑西林的处方（在乌干达五岁以下发热疾病常见病因的治疗中并无指征）。研究结果可能与诊断能力有限和抗生素供应不足有关，在旨在改善五岁以下发热门诊患者合理使用抗生素的干预措施中，这些问题需要优先解决。
