Olaru Ioana D, Chingono Rudo M S, Mhino Fadzaishe, Gregson Celia, Bottomley Christian, Bandason Tsitsi, Mpandaguta Chipo E, Madziva Karlos, Ferrand Rashida A, Vere Michael, Chonzi Prosper, Munyati Shungu, Dixon Justin, Darton Thomas C, Kranzer Katharina
The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.
Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom.
PLOS Glob Public Health. 2025 Apr 8;5(4):e0004442. doi: 10.1371/journal.pgph.0004442. eCollection 2025.
Low- and middle-income countries (LMIC) continue to experience a high burden of infectious diseases and disparities in access to and use of antimicrobials, yet data on antibiotic prescribing in outpatient settings, where the majority of global prescriptions occur, remain scarce. The objective of this study is to provide data on diagnoses and antibiotic prescriptions among primary care patients in Harare, Zimbabwe. We conducted a retrospective study of medical records from eight primary care clinics in Harare, Zimbabwe. Clinics were selected based on the population they served and the availability of records. Patient consultations conducted between January 2016 and December 2022 were included. Antibiotic prescriptions were categorised into groups according to the AWaRe (Access, Watch and Reserve) classification. During the study period, 199,880 patient consultations were recorded. The median patient age was 9 years and 52.5% (105,035/199,880) were female. The most common causes of presentation were due to infectious diseases including, in order of frequency, gastroenteritis (15.2%; 30,352/199,880), acute respiratory infections (10.9%; 21,381/199,880) and pneumonia (10.5%; 20,889/199,880). Overall, antibiotics were prescribed in 70.5% (117,674/166,858) of patients who were not referred to hospital. Antibiotics commonly prescribed were amoxicillin (39.4%; 65,825/166,858), ciprofloxacin (10.3%; 17,162/166,858), metronidazole (9.4%; 15,681/166,858). Among those who were prescribed antibiotics and not referred, 70.6% (83,034/117,674) were prescribed 'Access' and 29.3% (34,472/117,674) 'Watch' group antibiotics. Patients with respiratory infections, including those with upper respiratory infections, and gastroenteritis were frequently prescribed antibiotics. This study shows that infectious diseases remain a common reason for primary care presentation and antibiotics were frequently prescribed. These findings highlight the need for increasing access to diagnostics in primary care, and for antibiotic stewardship and other context-adapted interventions aimed at optimising patient management and reducing unnecessary antibiotic prescriptions.
低收入和中等收入国家（LMIC）仍然承受着传染病的沉重负担，在获得和使用抗菌药物方面存在差异，然而，在全球大多数处方开具的门诊环境中，关于抗生素处方的数据仍然很少。本研究的目的是提供津巴布韦哈拉雷初级保健患者的诊断和抗生素处方数据。我们对津巴布韦哈拉雷八家初级保健诊所的病历进行了回顾性研究。诊所根据其服务的人群和记录的可用性进行选择。纳入了2016年1月至2022年12月期间进行的患者会诊。抗生素处方根据AWaRe（可及、慎用和储备）分类进行分组。在研究期间，记录了199,880次患者会诊。患者年龄中位数为9岁，52.5%（105,035/199,880）为女性。最常见的就诊原因是传染病，按频率依次为肠胃炎（15.2%；30,352/199,880）、急性呼吸道感染（10.9%；21,381/199,880）和肺炎（10.5%；20,889/199,880）。总体而言，在未转诊至医院的患者中，70.5%（117,674/166,858）的患者开具了抗生素。常用的抗生素为阿莫西林（39.4%；65,825/166,858）、环丙沙星（10.3%；17,162/166,858）、甲硝唑（9.4%；15,681/166,858）。在开具了抗生素且未转诊的患者中，70.6%（83,034/117,674）的患者开具了“可及”类抗生素，29.3%（34,472/117,674）的患者开具了“慎用”类抗生素。患有呼吸道感染（包括上呼吸道感染）和肠胃炎的患者经常被开具抗生素。本研究表明，传染病仍然是初级保健就诊的常见原因，抗生素的开具频率较高。这些发现凸显了增加初级保健中诊断服务可及性的必要性，以及开展抗生素管理和其他因地制宜的干预措施以优化患者管理并减少不必要抗生素处方的必要性。
