AMR: Infrequent Use of Laboratory Diagnostics Likely Main Cause
By Mary Hearty
Infrequent use of laboratory diagnostics to guide medical specialists in prescribing appropriate antibiotics for patients could be one of the main causes of antimicrobial resistance (AMR) in Kenya and other countries in Africa.
This is according to a new survey done in three health facilities in Kenya -namely Kenyatta National Hospital , Coastal Provincial General Hospital, and Moi Teaching and Referral Hospital.
The research which was published at Plos One journal showed that of the 489 patients using antibiotics at the three hospitals, 442 had a single documented diagnosis, 39 had two diagnosis and eight had three diagnoses.
Moreover, 22% of the patients who had a single diagnosis were given antibiotics for prophylaxis and 32% were given antibiotics for an unspecified infectious condition.
According to the researchers given that the patients bear the cost of diagnostic testing and that fewer than 20% have health insurance coverage, clinicians may opt for empiric antibiotic therapy to help patients manage the cost of treatment, influencing their antibiotic prescription decision.
Empiric antibiotic therapy is antibiotic treatment that acts on both susceptible and non-susceptible bacteria, diverse fungi and parasites respectively, according to World Health Organization (WHO).
Moreover, at the time of the study, 2017-2018, they stated that no hospital required antimicrobial prescription pre-approval from another physician or pharmacist before administration or required that medical records include a rationale for antibiotic prescription.
They recommended solutions that prioritize laboratory testing to support antimicrobial prescribing practices and those that eliminate the barriers faced by clinicians in using laboratory services. For example, the cost of diagnostics could be subsidized to encourage their use.
Additionally, the researchers suggested that application of regulatory frameworks that incentivize appropriate antibiotic use, require review of prescription practices, or provide oversight committees with more authority to influence practitioner behavior should be considered
Notably, the researcher reported that the five most common infections were soft tissue infections, clinical sepsis, pneumonia, central nervous system infections and gynecological infections. Samples were collected in the form of blood, urine, stool and sputum
They also noted that antibiotic use was higher among children under the age of 5 years compared to other age groups as they were about 70% of the overall patients.
The commonly administered antibiotics in the three facilities during the survey period were amikacin, gentamicin, amoxicillin/clavulanate, benzylpenicillin, ceftriaxone, cefuroxime, flucloxacillin, meropenem, metronidazole, and sulfamethoxazole/trimethoprim.
According to the survey, beta-lactam antibiotics such as amoxicillin and ceftriaxone which had been reported in other surveys in Kenya and other African countries, were the most used antibiotics, followed by metronidazole.
Meropenem, one of the new beta-lactam antibiotics used for treating drug-resistant bacteria was the least used. “This may be because meropenem and other carbapenems are not included in Kenya’s Essential Medicines List and are reserved for the treatment of unmanageable infections under the guidance of an infectious disease specialist,” the researchers noted.
Furthermore, they observed that antibiotic use was significantly higher among patients with catheter insertion- tube that carries urine from the bladder to the outside of the body, tube insertions or surgical procedures, noting that they may have more severe diseases.
Overall, the prevalence of antibiotic use in health facilities in Africa has been found to be higher than what is reported in other regions across the globe.
This has been confirmed by this new study as it indicated 46% prevalence of antibiotic use in the three facilities. This finding is backed up by other separate multi-facility surveys within Africa that have reported antibiotic use prevalence estimates of 56% (9 hospitals in Nigeria), 59% (18 hospitals in Egypt) and 65% (39 hospitals in Benin).
Comparatively, Europe had a prevalence of 32% (32 countries, 251 hospitals), USA had 38% (6 countries, 43 hospitals), and Asia had 39% (15 countries, 56 hospitals)
Another recent survey results in two public referral hospitals in Kenya reported 68% and 55% prevalence of antibiotic use. Additionally, the 2015 Global Point-prevalence Survey reported that 50% of hospitalized adults were using antibiotics at the time of survey.