Evaluation of antibiotic prescribing patterns for empirical therapy of neonatal sepsis at women and new born hospital, Lusaka, Zambia.
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Date
2020
Authors
Muzyamba, Malambo
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Publisher
The University of Zambia
Abstract
Antibiotics are the most commonly prescribed and used drugs in the treatment of neonatal sepsis. Inappropriate use of antibiotics is associated with increased microbial resistance and neonatal mortality. Therefore, this study was set out to determine the antibiotic prescribing patterns for empirical therapy of neonatal sepsis at Women and Newborn Hospital in Lusaka, Zambia. This will help public health to combat inappropriate antibiotic prescribing and prevent antibiotic resistance and reduce mortality. This was a cross-sectional study conducted at the Women and Newborn Hospital, Neonatal intensive care unit Lusaka, Zambia, from May 2018 to August 2018. Data on 134 neonates were collected using a structured questionnaire. Data on demographic characteristics, appropriateness of dose, the frequency of administration, duration of treatment, and most prescribed antibiotics and conditions affecting the neonates were collected. Systematic sampling was used for the selection of participants. Before initiation of treatment, a single blood sample was collected from each neonate for culture and susceptibility testing. Samples were cultured on blood agar, chocolate and MacConkey. The organisms isolated from positive culture were identified using conventional biochemical techniques. Data analysis was conducted using STATA version 13. Of the 134 neonates studied, total inappropriateness was 39.1(29.2%) The dose inappropriate was 10(7%), inappropriate frequency of administration 15(11%) and inappropriate duration of treatment 15.01(11.2%). The most inappropriate prescribed drug was imipenem at least 11times out of 134. The most common condition associated with inappropriateness was sepsis with respiratory distress 14(10.4%) other conditions 12(9.0%) and sepsis with low birth weight 8(6.0%). Of all the samples that were cultured only 22(16.4%) samples had bacterial growth (12Coagulase Negative-Staphylococcus, 5Gram-negative bacilli, 2Escherichia coli and 3 Klebsiella). Coagulase Negative-Staphylococcus was susceptible to amikacin, gentamycin chloramphenicol, and vancomycin and intermediately susceptible to ciprofloxacin and resistant to co-trimoxazole and penicillin. Gram-negative bacilli were susceptible amikacin, imipenem and resistant to ceftriaxone, penicillin gentamycin and ciprofloxacin. While Escherichia coli and Klebsiella sp were resistant to ceftriaxone, gentamycin and penicillin and susceptible to amikacin, chloramphenicol and Imipenem. In the multivariate logistic analysis, only antibiotics and disease state were significantly associated with inappropriateness. In conclusion: There seems to be inappropriate prescribing of antibiotics in neonates with sepsis at Women and Newborn Hospital in Zambia. There is a need for the hospital (NICU) to enforce adherence to treatment protocols by the prescriber.
Key words: Inappropriate, Antibiotic prescribing, Neonates, Sepsis
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Keywords
Infection in children. , Communicable diseases in children. , Infection--drug therapy--Child