Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan.
J Racial Ethn Health Disparities. 2024 Jun;11(3):1308-1329. doi: 10.1007/s40615-023-01610-9. Epub 2023 May 8.
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.
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.
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.
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.
在非洲，关于住院患者抗生素使用的速率和质量指标的数据很少。本系统评价评估了非洲各地医院使用的抗生素的汇总流行率、适应证和类型。
使用搜索词在三个电子数据库 PubMed、Scopus 和非洲期刊在线 (AJOL) 中进行搜索。选择了 2010 年 1 月至 2022 年 11 月期间以英语发表的抗生素在住院患者环境中使用的点流行率研究。通过检查选定文章的参考文献列表，确定了其他文章。
从数据库中确定的 7254 篇文章中，有 28 篇符合条件的文章被选中，涉及 28 项研究。大多数研究来自尼日利亚（n=9）、加纳（n=6）和肯尼亚（n=4）。总体而言，住院患者抗生素使用的流行率范围为 27.6%至 83.5%，西非（51.4%-83.5%）和北非（79.1%）的流行率高于东非（27.6%-73.7%）和南非（33.6%-49.7%）。重症监护病房（ICU）（64.4%-100%；n=9 项研究）和儿科医疗病房（10.6%-94.6%；n=13 项研究）的抗生素使用率最高。社区获得性感染（27.7%-61.0%；n=19 项研究）和外科抗生素预防（SAP）（14.6%-45.3%；n=17 项研究）是抗生素使用的最常见适应证。SAP 的持续时间超过 1 天的比例为 66.7%至 100%。最常开的抗生素包括头孢曲松（7.4%-51.7%；n=14 项研究）、甲硝唑（14.6%-44.8%；n=12 项研究）、庆大霉素（n=8 项研究；范围：6.6%-22.3%）和氨苄西林（n=6 项研究；范围：6.0%-29.2%）。抗生素处方中，可获得、观察和保留组抗生素分别占 46.3%-97.9%、1.8%-53.5%和 0.0%-5.0%。抗生素处方的原因和停止/审查日期的记录范围分别为 37.3%-100%和 19.6%-100%。
非洲住院患者抗生素使用的时点流行率相对较高，且在该大陆不同地区之间存在差异。与其他病房相比，ICU 和儿科医疗病房的抗生素使用率更高。抗生素最常用于社区获得性感染和 SAP，头孢曲松、甲硝唑和庆大霉素是最常开的抗生素。建议进行抗生素管理，以解决 SAP 的过度使用问题，并降低 ICU 和儿科病房的高抗生素处方率。
