Costantine Judith K, Bwire George M, Myemba David T, Sambayi Godfrey, Njiro Belinda J, Kilipamwambu Amosi, Ching'oro Novatus, Shungu Rehema S, Mganga Mathew, Majigo Mtebe V
Department of Pharmacognosy, School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania.
Department of Pharmaceutical Microbiology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania.
JAC Antimicrob Resist. 2023 Aug 3;5(4):dlad093. doi: 10.1093/jacamr/dlad093. eCollection 2023 Aug.
Antibiotic prescribing should be guided by national essential medicines lists (NEMLs) and treatment guidelines; however, there are inadequate data on antibiotic utilization patterns in tertiary hospitals in Tanzania. This study aimed to determine antibiotic prescribing patterns in tertiary hospitals in Dar es Salaam, Tanzania.
A retrospective cross-sectional study was conducted in three regional referral hospitals. About 200 prescription records from 2020 to 2022 were analysed at each hospital for prescribing patterns using WHO/ International Network of Rational Use of Drugs (INRUD) indicators (1993) and the AWaRe 2021 classification. Factors associated with receiving an antibiotic prescription were assessed using a logistic regression model. Facilities were ranked on prescribing practices using the index of rational drug prescribing (IRDP).
A total of 2239 drugs were prescribed, of which 920 (41.1%) were antibiotics. An average of 3.7 ± 1.5 (optimal: 1.6-1.8) total medicines and 1.53 ± 0.78 antibiotics were prescribed per patient. About 88.0% (528) of the prescriptions contained antibiotics (optimal: 20.0%-26.8%), while 78.2% (413) of all antibiotic prescriptions contained injections (optimal: 13.4%-24.1%). Furthermore, 87.5% (462) of the antibiotics were prescribed in generic names (optimal: 100%), while 98.7% (521) conformed to the NEML (optimal: 100%). Metronidazole was the most frequently prescribed antibiotic (39.2%; = 134), followed by ceftriaxone (37.1%, = 127) and amoxicillin/clavulanic acid (8.5%, = 29).
We found substantial empirical prescribing and overuse of antibiotics exceeding WHO recommendations. Antibiotic overuse varied across the hospitals. Being male, having underlying conditions such as diabetes mellitus, and/or being treated at Temeke hospital were associated with receiving an antibiotic prescription. We recommend strengthening antibiotic stewardship programmes in the studied facilities.
抗生素的处方应依据国家基本药物清单（NEMLs）和治疗指南；然而，坦桑尼亚三级医院抗生素使用模式的数据并不充分。本研究旨在确定坦桑尼亚达累斯萨拉姆市三级医院的抗生素处方模式。
在三家地区转诊医院开展了一项回顾性横断面研究。每家医院分析了2020年至2022年约200份处方记录，以使用世界卫生组织/合理用药国际网络（INRUD）指标（1993年）和2021年AWaRe分类法确定处方模式。使用逻辑回归模型评估与接受抗生素处方相关的因素。根据合理用药处方指数（IRDP）对各医疗机构的处方行为进行排名。
共开出2239种药物，其中920种（41.1%）为抗生素。每位患者平均开出3.7±1.5（最佳：1.6 - 1.8）种药物和1.53±0.78种抗生素。约88.0%（528份）的处方含有抗生素（最佳：20.0% - 26.8%），而所有抗生素处方中有78.2%（413份）含有注射剂（最佳：13.4% - 24.1%）。此外，87.5%（462种）的抗生素以通用名开具（最佳：100%），而98.7%（521种）符合国家基本药物清单（最佳：100%）。甲硝唑是最常开具的抗生素（39.2%；n = 134），其次是头孢曲松（37.1%，n = 127）和阿莫西林/克拉维酸（8.5%，n = 29）。
我们发现抗生素的经验性处方和过度使用情况严重，超出了世界卫生组织的建议。各医院的抗生素过度使用情况各不相同。男性、患有糖尿病等基础疾病以及/或在特梅克医院接受治疗与接受抗生素处方有关。我们建议在所研究的医疗机构加强抗生素管理计划。
