Evaluation of Antimicrobial Prescribing Patterns at a Referral Hospital in Mbeya, Tanzania

Jason Siebert BS, Jeff Hall MD, Matthew Haldeman MD

Objectives: Antimicrobial resistance is a growing international concern. While many high-income countries have developed empiric antibiotic stewardship recommendations, lower- and middle-income countries have differing levels of antibiotic resistance. Therefore, antimicrobial resistance surveillance and stewardship is needed in these countries in order to develop local recommendations on how to combat antimicrobial resistance.. With collaboration with Mbeya Zonal Hospital of Tanzania, this study aims at looking at the effectiveness of an antimicrobial stewardship handbook created in the spring of 2018, which was designed to act as comprehensive guidelines on management of illness and the subsequent appropriate antimicrobial therapy. The study aims to follow up and look for any changes regarding antibiotic course completion and use by infectious indication after the adoption and implementation of the guidebook.

Methods: This study used chart reviews of 122 total evaluable courses of prescription medications. Each prescription course was measured to be complete if every prescribed dose of medication was taken by the patient. If a patient course was truncated by their discharge from the hospital or their death, the course was marked as truncated and excluded from the final calculations. In cases where the patient took more than the prescribed dose, the chart was marked as complete and the additional doses were marked as exceeding prescribed duration. If the patient failed to complete all doses prescribed, the course was marked as incomplete and the average number of missed doses were calculated for all incomplete courses and compared to results pre-intervention.

Results: Of 122 total evaluable courses, 16 were truncated by death or discharge, leading to 104 courses that were examined24 (23%) of courses were completed. Of the 80 (77%) of courses that were not completed, there was an average dose missed of 4.52 for the first course of medication, 5.44 for the second course of antibiotic, and an average of 2 missed doses for a 3rd course of medication if applicable.

Conclusion: Antibiotic stewardship remains a continuing area for improvement. The results indicate that the guidebook was not implemented in an effective way and efforts are ongoing to find additional ways to improve stewardship at Mbeya.