Knowledge and Antibiotics Prescription Pattern among Ugandan Oral Health Care Providers: A Cross-sectional Survey

Antimicrobial prescription patterns in East Africa: a systematic review

BACKGROUND

Antimicrobial resistance is currently a recognized global health problem stemming from poor antibiotic stewardship by health workers and inappropriate antimicrobial use by patients. Data showing the extent of poor antimicrobial stewardship in low- and middle-income countries are scanty though high incidences of antimicrobial resistance are increasingly reported in many settings across the globe. The objective of the present study was, therefore, to evaluate prescriptions for antimicrobials in East Africa.

METHODS

A comprehensive literature search strategy that includes text words and medical subject headings was developed and applied to predefined electronic databases. Two authors independently screened the titles and abstracts of the outputs of the literature search. Full texts were then independently reviewed by the first and the second authors. Eligible studies were formally assessed for quality and risk of bias using a scoring tool. Extracted data from included studies were combined in a meta-analysis where appropriate and presented using forest plots and tables or in a narrative text. Where data were available, subgroup analyses were performed.

RESULTS

A total of 4284 articles were retrieved, but only 26 articles were included in the review. The majority of the included studies (30.8%) were retrieved from Ethiopia, followed by Sudan, Kenya, and Tanzania each contributing 19.2% of the included studies. The overall proportion of encounters with antimicrobials reported by the included studies was 57% CI [42-73%]. Ethiopia had an overall patient encounter with antimicrobials of 63% [50-76%] followed by Sudan with an overall encounter with antimicrobials of 62% CI [34-85%]. Included studies from Kenya reported an overall encounter with antimicrobials of 54% CI [15-90%], whereas included studies from Tanzania reported an overall patient encounter with antimicrobials of 40% CI [21-60%].

CONCLUSION

Prescription patterns demonstrated in this review significantly deviate from WHO recommendations suggesting inappropriate antimicrobial use in the East African countries. Further studies have to be pursued to generate more information on antimicrobial use in this region.

An Evaluation of Antibiotic Prescription Rationality at Lower Primary Healthcare Facilities in Three Districts of South-Western Uganda

Purpose

Antimicrobial resistance is now one of the leading five causes of death globally. This study evaluated the rationality of antibiotic prescriptions at lower primary care levels in three districts of Southwestern Uganda.

Methods

This prospective cross-sectional study reviewed 9899 antibiotic prescriptions at 39 health centers following a drug delivery cycle by National Medical Stores in three phases (19 days each on average). Phase 1 started 3 days after delivery, mid-way (Phase 2) and towards the end (Phase 3). The proportion of rationally prescribed antibiotics was determined using a modified criterion by Badar and in reference to Uganda Clinical Guidelines (UCG). Using multivariate logistic regression, the factors associated with rational prescription were determined with 95% confidence intervals.

Results

Seven of every 10 antibiotic prescriptions were irrational. Half the prescriptions were made by unauthorized personnel (nurses) and many of the pediatric prescriptions (916, 46.5%) did not bear body weight measurements to guide appropriate dosing. Also, the proportion of rational prescriptions in reference to UCG, 2016 was very low (3387, 34.2%). However, a high proportion of antibiotic prescriptions were legibly written (9462, 95.7%), prescribed by generic names (9083, 91.8%) and had a diagnosis (9677, 97.8%) indicated. Multivariate logistic analysis showed that; availability of medicines (phase 1) (phase 2 AOR=1.14, 95% CI:1.02-1.28, phase 3, AOR=1.23, 95% CI:1.1-1.38), legibly written prescription (AOR=0.61, 95% CI: 0.47-0.78), indication of a date on the prescription (AOR=0.56, 95% CI0.38-0.81) and being a medical officer were factors associated with rational antibiotic prescription.

Conclusion

We observed a high rate of irrational prescription in the study sites and the majority of these were by unauthorized personnel. A review of antibiotic use policies and focused interventions is crucial in these settings.

Are Dutch dental students and dental-care providers competent prescribers of drugs?

Dental students and dental‐care providers should be able to prescribe drugs safely and effectively. As it is unknown whether this is the case, we assessed and compared the prescribing competence of dental students and dental‐care providers in the Netherlands. In 2017, all Dutch final‐year dental students and a random sample of all qualified general dental practitioners and dental specialists (oral and maxillofacial surgeons and orthodontists) were invited to complete validated prescribing knowledge‐assessment and skills‐assessment instruments. The knowledge assessment comprised 40 multiple‐choice questions covering important drug topics. The skills assessment comprised three common clinical case scenarios. For the knowledge assessment, the response rates were 26 (20%) dental students, 28 (8%) general dental practitioners, and 19 (19%) dental specialists, and for the skills assessment the response rates were 14 (11%) dental students, eight (2%) general dental practitioners, and eight (8%) dental specialists. Dental specialists had higher knowledge scores (78% correct answers) than either dental practitioners (69% correct answers) or dental students (69% correct answers). A substantial proportion of all three groups made inappropriate treatment choices (35%–49%) and prescribing errors (47%–70%). Although there were some differences, dental students and dental‐care providers in the Netherlands lack prescribing competence, which is probably because of poor prescribing education during under‐ and postgraduate dental training. Educational interventions are urgently needed.

Knowledge of antibiotic resistance and antibiotic prescription practices among prescribers in the Brong Ahafo Region of Ghana; a cross-sectional study

Background

Antibiotic resistance (ABR) has become a major public health challenge in most parts of the world including Ghana and is a major threat to gain in bacterial disease control. The role of prescribers in the control of antibiotics is identified as crucial in developing interventions to control ABR. To guide policy recommendations on ABR, a study was carried out among prescribers to identify gaps in their knowledge of ABR and to document their prescription practices.

Method

A cross-sectional survey was conducted among prescribers from both public and private facilities in the Brong Ahafo Region of Ghana using both quantitative and qualitative methods in 2014.

Results

Three hundred and seventy nine prescribers participated in the quantitative study and a subset of 33 participated in in-depth interviews. Majority (50.0%) of the prescribers interviewed were nurses. Most (51.0%) of the prescribers were located in hospitals. Knowledge of ABR was high among all the prescribers. About 80.0% percent of all prescribers agreed that the antibiotics that are currently used could lose its efficacy in future. There is no singular formal source of information on antibiotic resistance. The prescribers held a strong perception that antibiotic resistance is imminent though their knowledge on various resistant bacterial strains was limited. Prescribers attributed ABR burden to factors such as poor prescription practices and limited ABR control measures. The prescription practices of the prescribers vary but were mostly inappropriate among the lower cadre.

Conclusion

The knowledge of ABR is high among prescribers. There is however a gap in the knowledge and perception of optimal antibiotic prescription practices among prescribers. There is the need for a formal source of information on ABR to support prescriber’s antibiotic prescription practices.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-017-2365-2) contains supplementary material, which is available to authorized users.

Level of understanding of co-trimoxazole use among HIV infected, recurrent pulmonary tuberculosis suspects at a national referral tuberculosis clinic in Kampala, Uganda: a qualitative analysis

BACKGROUND

Co-trimoxazole use is the standard of care for preventing Pneumocystis jirovecii pneumonia in sub-Saharan Africa but implementation remains slow. Co-trimoxazole is self- administered with uncertain adherence. Knowledge of co-trimoxazole use among HIV infected persons is unknown.

OBJECTIVES

To assess knowledge, attitudes and practices of co-trimoxazole use among HIV infected adults evaluated for recurrent PTB in Kampala, Uganda.

METHODS

A qualitative study utilizing 5 focus group discussions among 30 HIV infected PTB suspects at the national referral tuberculosis treatment centre in Kampala.

RESULTS

Males and females had similar median ages. 80% were currently on co-trimoxazole and 50% of participants were on HAART. Majority of participants defined co-trimoxazole as an analgesic. Few noted co-trimoxazole was a drug to treat cough and chest pain. However, few responses revealed that co-trimoxazole prevents opportunistic diseases among PLHIV. Most of participants believed HAART and anti-TB drugs work as co-trimoxazole thus it should not be taken together with them. This belief may lead to increased risk of opportunistic infections, morbidity and mortality.

CONCLUSIONS

We revealed gaps in understanding of co-trimoxazole use among study participants. We therefore recommend that more facts about co-trimoxazle as prophylaxis against P. jirovecii, bacterial and diarrheal pathogens should be incorporated in VCT fact sheets.

Characteristics of pyogenic odontogenic infection in patients attending Mulago Hospital, Uganda: a cross-sectional study

Background

Predisposing factors of pyogenic odontogenic infection include dental caries, pericoronitis, periodontitis, trauma to the dentition and the supporting structures or complications of dental procedures. The infections are usually polymicrobial involving normal endogenous flora. We characterised pyogenic odontogenic infection in patients attending Mulago Hospital, Uganda.

Results

Of the 130 patients, 62 (47.7%) were female. The most frequently involved fascial spaces were: the buccal, 52 (25.4%); submasseteric, 46 (22.4%) and the submandibular space, 36 (17.5%). Dental caries was the most prevalent predisposing factor, particularly of the lower third molar teeth. Viridans Streptococci Group and Staphylococcus aureus were the most frequent bacterial isolates: 23.5% and 19.4%, respectively. All Viridans Streptococci isolates were resistant to penicillin G, sulfamethoxazole/trimethoprim (cotrimoxazole), ampicillin and tetracycline, but susceptible to vancomycin. All Staphylococcus aureus strains were resistant to cotrimoxazole and ampicillin while retaining susceptibility to vancomycin, cefotaxime, linezolid, moxifloxacin and amoxicillin/clavulanate. Thirty five (26.9%) patients were HIV infected and the HIV status did not significantly influence the pattern of odontogenic infection.

Conclusions

Dental caries was the most prevalent predisposing factor for pyogenic odontogenic infection. High prevalence of bacterial resistance to ampicillin and cotrimoxazole suggests the need for regular antibiotic susceptibility tests of isolates and rational use of antibiotics in the management of these infections. Prevention requires strengthening of oral health in the community.

Current Trend of Antimicrobial Prescription for Oral Implant Surgery Among Dentists in India

OBJECTIVES

The aim of our study was to evaluate antimicrobial prescription behaviour amongst dentists performing oral implant surgery in India.

STUDY DESIGN

Dentists performing oral implant surgery from different parts of India were personally approached during various national events such as conferences and academic meetings and information regarding their prescription habits for antimicrobial agents in routine oral implant surgery was collected using a structured questionnaire.

RESULTS

Out of a total sample of 332 dentists, 85.5 % prescribed 17 different groups or combinations of antibiotics routinely for oral implant surgery in the normal healthy patient. Majority preferred the peri-operative protocol of drug therapy (72.2 %) with variable and prolonged duration of therapy after surgery, ranging from 3 to 10 days. An antimicrobial mouthwash was routinely prescribed by all the doctors (14.5 %) not in favour of prescribing antimicrobials in a normal healthy patient.

CONCLUSIONS

Our findings suggest that there is a trend of antimicrobial agent misuse by dentists performing oral implant surgery in India, both in terms of drugs used and the protocols prescribed. The majority of these dentists prescribed a variety of antimicrobial agents for prolonged durations routinely even in the normal, healthy patients.

Knowledge and Pattern of Antibiotic and Non Narcotic Analgesic Prescription for Pulpal and Periapical Pathologies- A Survey among Dentists

AIM

The objective was to assess the knowledge and pattern of antibiotic and non narcotic analgesic prescription for pulpal and periapical pathologies among dentists, registered with IDA, in and around Hyderabad.

MATERIALS AND METHODS

Cross-sectional survey was conducted from January 2014 to February 2014 in and around Hyderabad, Andhra Pradesh, India. A questionnaire for this cross-sectional survey was designed for evaluating the knowledge and patterns of antibiotic and non narcotic analgesic prescription for pulpal and periapical pathologies. It included some demographic information, questions regarding clinical and non clinical factors, type of antibiotics and non narcotics analgesics prescribed were recorded. Data was computed and analysed using SPSS software. Descriptive statistics was performed.

RESULTS

The response rate for the study was 85%, 51.4% being males and 53.9% were pursuing post graduation. Of the respondents, 44.3% would prescribe medication with elevated body temperatures and evidence of systemic involvement, while 42.8% would prescribe medication for non clinical factors such as unsure of diagnosis. Necrotic pulp with acute apical periodontitis with swelling present and mod/severe preoperative symptoms was the most common condition identified for antibiotic therapy (56.4%). The first antibiotic of choice in patients with no medical allergies is amoxicillin, followed by amoxicillin and metronidazole. The first antibiotic of choice in case of allergic to penicillin was erythromycin. 55.1% and 37.3% would not prescribe antibiotic and analgesic after Root canal treatment respectively. The most commonly prescribed NSAID is Diclofenac (51.1%). Factors influencing the choice of analgesics among respondents is severity of pain (61.4%). 31.7% remained informed of current prophylactic practices through pharmaceutical companies followed by university training sessions and scientific societies (30.7%).

CONCLUSION

The results of the present survey have demonstrated a lack of uniformity among the dental practitioners. All the clinicians should make themselves aware of the current guidelines available, to ensure highest degree of patient care.

Aetiology of pulmonary symptoms in HIV-infected smear negative recurrent PTB suspects in Kampala, Uganda: a cross-sectional study

Introduction

Previously treated TB patients with pulmonary symptoms are often considered recurrent TB suspects in the resource-limited settings, where investigations are limited to microscopy and chest x-ray. Category II anti-TB drugs may be inappropriate and may expose patients to pill burden, drug toxicities and drug-drug interactions.

Objective

To determine the causes of pulmonary symptoms in HIV-infected smear negative recurrent pulmonary tuberculosis suspects at Mulago Hospital, Kampala.

Methods

Between March 2008 and December 2011, induced sputum samples of 178 consented HIV-infected smear negative recurrent TB suspects in Kampala were subjected to MGIT and LJ cultures for mycobacteria at TB Reference Laboratory, Kampala. Processed sputum samples were also tested by PCR to detect 18S rRNA gene of P.jirovecii and cultured for other bacteria.

Results

Bacteria, M. tuberculosis and Pneumocystis jirovecii were detected in 27%, 18% and 6.7% of patients respectively and 53.4% of the specimens had no microorganisms. S. pneumoniae, M. catarrhalis and H. influenzae were 100% susceptible to chloramphenicol and erythromycin but co-trimoxazole resistant.

Conclusion

At least 81.5% of participants had no microbiologically-confirmed TB. However our findings call for thorough investigation of HIV-infected smear negative recurrent TB suspects to guide cost effective treatment.