An evaluation of antibiotic prescribing practices based on the WHO AWaRe classification and associated factors at a private hospital in Kampala

Abstract

Background: Irrational antibiotic prescribing practices are a key driver for increasing antimicrobial resistance. Moreover, antibiotic use according to the World Health Organization (WHO) Access, Watch and Reserve (AWaRe) classification in Ugandan private hospitals is not known. This study measured antibiotic use, evaluated the associated factors and assessed the extent of preparedness for antibiotic stewardship practices at Case Hospital. Methods: A cross-sectional study design was utilized. Stratified random sampling with proportionate to size allocation between the out-patient and in-patient departments was used. The prevalence of non-Access category antibiotic use and associated factors were analyzed using modified Poisson regression. Preparedness to implement Antimicrobial stewardship (AMS) practices was analyzed by scoring the hospital’s performance against a set of standardized AMS practice indicators. Results: Overall antibiotic use prevalence was 45% (190/422). Non-Access category antibiotic use prevalence was 79.5% (151/190) with Azithromycin (Watch category) being the most frequently prescribed antibiotic at 13.6% (40/294). More than half of Azithromycin prescriptions with a documented diagnosis (52.9%) were for Respiratory tract infections. After adjusting for age and sex, patients prescribed ≥ 2 antibiotics were 33% significantly more likely to have received Non-Access antibiotics compared to those prescribed one (aPR: 1.33, 95% CI 1.16 – 1.54, p < 0.001). The hospital’s extent of preparedness for AMS practices as measured against a standardized AMS audit tool was low (41.2%). Conclusion: Non-Access category antibiotic use prevalence was about twice the WHO recommended limit of 40%. Additionally, the extent of preparedness to implement AMS practices at the facility was low. As such, there is need to strengthen and support effective functioning of the hospital’s Medicines and Therapeutics committee.