Improvements in Prescribing Indicators and Antibiotic Utilization Patterns Following Antimicrobial Stewardship Intervention at a District Hospital in Ghana
Abstract
1. Introduction
- i.
- compare the key WHO prescribing indicators;
- ii.
- compare the pattern of antibiotic prescriptions according to the WHO AWaRe classification.
2. Materials and Methods
2.1. Study Design
2.2. General Settings
2.3. Specific Settings
2.4. Process of Prescription and Issuing of Medicines to Outpatients in the University Hospital, KNUST
2.5. Antimicrobial Stewardship (AMS) Activities Undertaken at the University Hospital, KNUST, After the First Operational Research Study
2.6. Study Period
2.7. Study Population
2.8. Sample Size
2.9. Data Collection and Data Variables
2.10. Data Analysis
2.11. Operational Definitions
3. Results
3.1. Demographic and Clinical Characteristics
3.2. Comparison of Adherence to WHO Prescribing Indicators Between 2021 and 2023
3.3. Pattern of Antibiotic Prescriptions According to the WHO AWaRe (Access, Watch, Reserve) Classification in 2021 and 2023
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Appendix A.1. Dissemination Details of the Baseline Operational Research Study
How | To Whom | Where (Number) | When |
---|---|---|---|
Stakeholder engagement and communication planning | Officials of KNUST
| University Hospital, KNUST (13) | October 2021, June–August; October–December 2022, |
Evidence summaries (handouts summarizing study findings) | Healthcare providers and students of KNUST | Newsstand of the Dean’s office of the School of Pharmacy, KNUST (Approximately 15 staff and more than 100 students) | October 2022 to July 2023 |
Seminar attendees and via email | Ghana SORT IT AMR dissemination Seminar (36) | July 2023 | |
PowerPoint presentation and discussions | The study findings were disseminated during various training seminars conducted for staff of the University Hospital, KNUST and the students at the faculty of Clinical Pharmacy | Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, KNUST (10) | December 2022–January 2023 |
School of Graduate Studies, KNUST (approximately 35) | July 2023 to present (May 2024) | ||
Manuscript full text dissemination via emails | Representatives of
| August 2022 | |
Publication in a peer-reviewed journal | International Journal of Environmental Research and Public Health (IJERPH) | Reference 1 [14] (2157 article views according to IJERPH; 16 citations according to Google scholar) Reference 2 [15] (1582 article views according to IJERPH; 2 citations according to Google scholar) | August 2022 to present September 2022 to present |
Appendix A.2. Recommendations and Actions Taken Following the Baseline Operational Research Study
Recommendation | Action Status | Details of Action (When and What) |
---|---|---|
EMR is customized to control the prescription of Watch and Reserve antibiotics only to higher ranked prescribers and medical conditions in consultation with pharmacists | Partially implemented and ongoing | December 2022–present EMR changed to different type of management software. Director of Hospital in talks with software managers to incorporate custom controls on antibiotic prescriptions into new software |
OPD services included in the antimicrobial stewardship program | Implemented | July 2023–present Current iteration of antimicrobial stewardship activities including point prevalence surveys include outpatient services in purview, staff education and capacity building seminars. |
Six-monthly audit and feedback system for OPD prescriptions have been established | Implemented | Nov 2023, May 2024 On-going online point prevalence surveys to audit prescriptions |
Drafting of an antibiotic prescription policy document on antibiotic prescribing and use at the hospital | Implemented | September 2023 A policy document has been developed which covers outpatient and inpatient antibiotic use and the role of all the health cadres in the hospital in prescribing. Provisional approval has been given, awaiting formal adoption by Hospital Management Committee |
Additional research is planned with hospital management as a follow-up on outpatient and inpatient antibiotic use practices in the hospital. | Partially implemented and ongoing | November 2023–present Inpatient and outpatient point prevalence surveys ongoing. Routine audits of prescriptions on going. Publication for antibiogram developed on account of activities undertaken by AMS team under review by JAC-Antimicrobial Resistance |
Training seminars on AMR, AMS, and IPC organized for all health cadres at the hospital | Implemented and ongoing | July 2023–present Since inception of the AMS committee, various training seminars have been organized for staff of the university hospital on AMR. Newly appointed staff orientation exercise also includes AMR/AMS as important topic so that all staff are kept abreast of guidance before starting official duties at the hospital |
Additional funding for AMS, laboratory infrastructure and research | Partially implemented and ongoing | June 2023 Expansion of microbiology laboratory and acquisition of new equipment at the university hospital to conduct culture and sensitivity testing |
WHO AWaRe Group | Antibiotic | n | Percentage |
---|---|---|---|
Access | Ampicillin | 1 | 0.003 |
Chloramphenicol | 13 | 0.033 | |
Amikacin | 87 | 0.222 | |
Amoxicillin Clavulanic Acid | 9327 | 23.823 | |
Clindamycin | 1283 | 3.277 | |
Co-Trimoxazole | 28 | 0.072 | |
Doxycycline | 801 | 2.046 | |
Flucloxacillin | 869 | 2.22 | |
Gentamicin | 161 | 0.411 | |
Metronidazole | 3165 | 8.084 | |
Nitrofurantoin | 21 | 0.054 | |
Secnidazole | 443 | 1.131 | |
Tetracycline | 575 | 1.469 | |
Benzylpenicillin | 270 | 0.69 | |
Watch | Azithromycin | 2953 | 7.542 |
Cefaclor | 1 | 0.003 | |
Cefixime | 393 | 1.004 | |
Cefotaxime | 1 | 0.003 | |
Cefpodoxime | 62 | 0.158 | |
Ceftriaxone | 1007 | 2.572 | |
Cefuroxime | 3964 | 10.125 | |
Ciprofloxacin | 6869 | 17.544 | |
Clarithromycin | 365 | 0.932 | |
Erythromycin | 105 | 0.268 | |
Fusidic Acid | 1 | 0.003 | |
Levofloxacin | 880 | 2.248 | |
Neomycin | 1310 | 3.346 | |
Meropenem | 8 | 0.02 | |
Ofloxacin | 7 | 0.018 | |
Tobramycin | 1302 | 3.326 | |
Vancomycin | 1 | 0.003 | |
Fosfomycin | 1 | 0.003 | |
Reserve | Polymixin | 1308 | 3.341 |
Not Recommended | Ciprofloxacin/Tinidazole | 969 | 2.475 |
Unclassified | Mupirocin | 1 | 0.003 |
Bacitracin | 600 | 1.532 |
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Indicator | Numerator | Denominator | WHO Optimum |
---|---|---|---|
Proportion of patient encounters that result in an antibiotic prescription | Number of encounters in which an antibiotic was prescribed | Total patient encounters for which data were collected | <27% |
Average number of medicines per patient encounter | Total number of medicines prescribed | Total patient encounters for which data were collected | <2 |
Percentage of medicines prescribed by generic name | Total number of medicines prescribed in International Non-proprietary Names (INN) format | Total number of medicines prescribed in all patient encounters for which data were collected | 100% |
Percentage of encounters with an injection prescribed | Number of encounters in which an injectable form of medicine was prescribed | Total patient encounters for which data were collected | <20% |
Percentage of medicines prescribed from an essential medicines list | Total number of medicines prescribed from the EML | Total number of medicines prescribed | 100% |
Characteristics | 2021 | 2023 | p-Value | ||
---|---|---|---|---|---|
Number | (%) | Number | (%) | ||
Total number of patients | 49,660 | 65,157 | |||
Demographic characteristics | |||||
Age in years 1 | |||||
0–14 | 6301 | (12.7) | 8638 | (13.3) | <0.001 |
15–24 | 22,705 | (45.7) | 29,127 | (44.7) | |
25–34 | 7501 | (15.1) | 9433 | (14.5) | |
35–44 | 4004 | (8.1) | 5784 | (8.9) | |
45–54 | 3312 | (6.7) | 4365 | (6.7) | |
55–64 | 2867 | (5.8) | 3526 | (5.4) | |
≥65 | 2964 | (5.9) | 4280 | (6.6) | |
Sex | |||||
Male | 26,783 | (53.9) | 28,592 | (43.9) | <0.001 |
Female | 22,877 | (46.1) | 36,565 | (56.1) | |
Clinical characteristics | |||||
General OPD | 39,186 | (78.9) | 56,026 | (86) | <0.001 |
Dental | 2108 | (42.0) | 2286 | (3.5) | |
Diabetes/Hypertension clinic | 517 | (1.0) | 360 | (0.6) | |
Others 2 | 7849 | (15.8) | 6485 | (10) | |
Patient encounters | |||||
1 | 6108 | (12.3) | 27,306 | (41.9) | <0.001 |
2 | 7263 | (14.6) | 12,828 | (19.7) | |
3 | 10,542 | (21.2) | 10,406 | (15.9) | |
4 | 9827 | (19.8) | 7073 | (10.9) | |
5 | 7516 | (15.1) | 4051 | (6.2) | |
6 | 4287 | (8.6) | 1890 | (2.9) | |
>6 | 4117 | (8.3) | 1603 | (2.5) |
Group | 2021 | 2023 | % Change 2 | (95% CI) | p-Value | ||
---|---|---|---|---|---|---|---|
Number of Antibiotic Prescriptions (n = 58,885) | (%) 1 | Number of Antibiotic Prescriptions (n = 37,646) | (%) 1 | ||||
Access group | 28,152 | (47.8) | 18,013 | (47.8) | 0 | - | 0.9 |
Watch group | 27,395 | (46.5) | 19,237 | (51.1) | 4.6 | (3.9–5.2) | <0.001 |
Reserve group | 1045 | (1.8) | 1308 | (3.5) | 1.7 | (1.4–1.9) | <0.001 |
Not recommended (Ciprofloxacin-Tinidazole combination) | 1798 | (3.1) | 969 | (2.6) | −0.5 | (−0.7–−0.3) | <0.001 |
Unclassified 3 | 495 | (0.8) | 601 | (1.6) | 0.8 | (0.6–0.9) | <0.001 |
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Share and Cite
Abruquah, N.A.; Amponsah, O.K.O.; Nair, D.; Opoku, D.A.; Konadu, E.; Prajitha, K.C.; Osafo, A.B.; Buabeng, K.O.; Ayisi-Boateng, N.K. Improvements in Prescribing Indicators and Antibiotic Utilization Patterns Following Antimicrobial Stewardship Intervention at a District Hospital in Ghana. Trop. Med. Infect. Dis. 2025, 10, 282. https://doi.org/10.3390/tropicalmed10100282
Abruquah NA, Amponsah OKO, Nair D, Opoku DA, Konadu E, Prajitha KC, Osafo AB, Buabeng KO, Ayisi-Boateng NK. Improvements in Prescribing Indicators and Antibiotic Utilization Patterns Following Antimicrobial Stewardship Intervention at a District Hospital in Ghana. Tropical Medicine and Infectious Disease. 2025; 10(10):282. https://doi.org/10.3390/tropicalmed10100282
Chicago/Turabian StyleAbruquah, Nana Akua, Obed Kwabena Offe Amponsah, Divya Nair, Douglas Aninng Opoku, Emmanuel Konadu, Kannamkottapilly Chandrasekharan Prajitha, Annabella Bensusan Osafo, Kwame Ohene Buabeng, and Nana Kwame Ayisi-Boateng. 2025. "Improvements in Prescribing Indicators and Antibiotic Utilization Patterns Following Antimicrobial Stewardship Intervention at a District Hospital in Ghana" Tropical Medicine and Infectious Disease 10, no. 10: 282. https://doi.org/10.3390/tropicalmed10100282
APA StyleAbruquah, N. A., Amponsah, O. K. O., Nair, D., Opoku, D. A., Konadu, E., Prajitha, K. C., Osafo, A. B., Buabeng, K. O., & Ayisi-Boateng, N. K. (2025). Improvements in Prescribing Indicators and Antibiotic Utilization Patterns Following Antimicrobial Stewardship Intervention at a District Hospital in Ghana. Tropical Medicine and Infectious Disease, 10(10), 282. https://doi.org/10.3390/tropicalmed10100282