Pattern of inappropriate antibiotic use among patients in the medical wards of a tertiary hospital in southwest Nigeria

Background: The inappropriate use of antibiotics results in the emergence of antimicrobial resistance and adverse clinical and economic outcomes in hospital in-patients. A lack of institutional and national antibiotic guidelines promotes inappropriate antibiotic use. The objectives of this study are to evaluate the appropriateness of antibiotic prescribing, and the quality of antibiotic use in medical wards of the Lagos University Teaching Hospital, Lagos, Nigeria. Methodology: This was a descriptive cross-sectional study of patients admitted and placed on antibiotics in the medical wards of Lagos University Teaching Hospital between July 2013 and August 2014. The appropriateness of antibiotic therapy was determined by compliance with the guidelines of the Infectious Diseases Society of America (IDSA). Results: A total of 350 hospitalized patients on antibiotic therapy during the period of the study were reviewed, including 197 (56.3%) males and 153 females (43.7%). The mean age of the patients was 48.7±17.6 years and a total of 539 initial antibiotics were empirically prescribed. Antibiotic therapy was considered inappropriate in 290 (82.9%) patients, of which 131 (37.4%) patients had no evidence of infection. Pneumonia (23.1%) was the most common indication for antibiotic use, out of which 59.3% had inappropriate antibiotic therapy. Overall, the most frequently prescribed initial empirical antibiotic classes were imidazole derivatives (32.4%) and cephalosporins (22.0%), while the most frequently prescribed inappropriate antibiotic classes were carbapenems (100.0%) and quinolones (89.3%). Conclusion: The study revealed a high rate of inappropriate antibiotic therapy. There is an imperative need to establish antimicrobial stewardship programmes to curb the inappropriate use of antibiotics in the hospital.

Perception of doctors at Elobied teaching hospital toward antibiotics resistance as a health threat

Background: Resistance to antibiotics has increased dramatically over the past few years and has now reached a level that places future patients in real danger. Several factors contribute to this problem, some of them are health workers related and others are community related. This study aimed to assess the awareness of doctors in Elobeid hospital, North Kordofan state, Sudan about the problem, its causes, and its possible preventive measures. Methods: This descriptive, questionnaire-based study was conducted in Elobeid teaching hospital between 2020, February 27 and March 13. The study involved 50 doctors in the internal medicine department. Results: Out of the 50 doctors involved, 49 (98%) agreed that antibiotics resistance is a big progressive health threat in Sudan; 86% of the participants think that selfmedication is the leading cause of antibiotic resistance; and 98% believe that providing good quality culture and sensitivity service in hospitals and health centers is the most effective preventive measure. Regarding education about antibiotics as a part of academic activities in the unit during the last year, 36% of the participants received zero sessions, 68% received 1­5 sessions, and 12% received more than 5 sessions. The assessment of doctor's adherence to the Sudan Standard Treatment Guideline revealed that 28/50 participants (56%) did not see it or hear about it, 17/50 participants (34%) know it but don't comply, and only 5/50 participants (10%) know it and comply with it. Conclusion: Participants show a good awareness about the significance of antibiotics resistance as a health threat, a good awareness about the main causes and the possible preventive measures, a low to moderate frequency of education on antibiotics, and a very poor adherence to the Sudan Standard Treatment Guidelines.

Antimicrobial susceptibility of urinary bacterial isolates of pregnant women attending antenatal clinics of selected hospitals in Ilorin, Nigeria

Background: Fragmented service provision and a lack of efficient cooperation between health and welfare sectors serving children and families remain ongoing challenges in South Africa. The coronavirus disease 2019 (COVID-19) pandemic escalated this fragmentation. A community of practice (CoP) was established by the Centre for Social Development in Africa to promote collaboration between the sectors and to assist communities in their environments. Aim: To explore and describe collaboration on child health promotion between professional nurses and social workers, who formed part of the CoP during the COVID-19 pandemic. Setting: The study was conducted in five public schools from four of the seven district regions of the City of Johannesburg, Gauteng province. Methods: A qualitative, exploratory, descriptive research design was employed to conduct psychosocial and health screenings of children and their families. Focus group interviews were conducted, and field notes were used to collect and confirm data from the team. Results: Four themes emerged. Participants shared their positive and negative experiences faced during the fieldwork, their realisation of the value of collaboration between various sectors and their desire and capacity to do more. Conclusion: Participants indicated that collaboration between the health and welfare sectors is vital to support and promote the health of children and their families. The COVID-19 pandemic highlighted the need for collaboration between these sectors in the children and their families' ongoing struggles. Contribution: The importance of these sectors being engaged as a team highlighted the multisectoral influence shaping child development outcomes, supporting children's human rights and advancing social and economic justice.

Antibiotic prescription patterns in paediatric wards of Rivers State university teaching hospital, southern Nigeria: a point prevalence survey

Antimicrobial resistance remains a threat to patient safety and healthcare outcomes and largely arises from inappropriate antimicrobial prescriptions. This study aimed to determine the pattern of antibiotic prescriptions in the Paediatrics department of Rivers State University Teaching Hospital, Port Harcourt.Method:A point prevalence survey was conducted in the Paediatric wards and Special Care Baby Unit (SCBU) on 13 November 2021. Records of all children admitted before or at 8:00a.m. on the day of the survey were descriptively analysed using the protocol and web-based management system of the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance, University of Antwerp.Results: The antibiotic prevalence in this study was 77.4%. The most common indication(s) for antibiotic use in SCBU was infection prophylaxis (81.3%) and in paediatric wards: Pneumonia, Ear Nose Throat and Soft tissue infections accounted for (23.1%) each. Third-generation cephalosporins and aminoglycosides were predominantly used in all wards and were empirical-based prescriptions. Regarding antibiotic quality indicators of prescriptions: In SCBU: 19 (90.5%) had indication(s) for antibiotics documented, 10 (46.7%) were guideline compliant, and 1 (4.8%) had documented review/stop date. In the paediatric medical and surgical wards, 17(85.0%) vs. 4(100%) had indication(s) for antibiotics documented, 6(30.0%) vs. 0(0%) were guideline compliant, and 1(5.0%) vs. 4(100.0%) had a review/ stop date.Conclusion:High prevalence of antibiotic use, suboptimal antibiotic quality indicators and absence of laboratory evidence for antibiotic prescriptions were observed in the paediatric units. There is a need to reorientate prescribers and institute strategic measures to improve antimicrobial stewardship

Prevalence of multi-drug resistant Pseudomonas aeruginosa isolated from selected residential sewages in Dutsin-Ma, Katsina State, Nigeria

The global surge in Multidrug resistant (MDR) bacteria is an issue of great concern. Pseudomonas aeruginosa has been implicated in several nosocomial infections, where it has caused grave complications in immunocompromised patients. This is the first study to report the prevalence of MDR P. aeruginosa isolated from residential sewage in Dutsin-Ma, Katsina State, Nigeria. Pseudomonads count, isolation, biochemical characterization and antibiogram were carried out using standard microbiological procedures. This study examined sixty (60) samples from selected residential sewage in the study site collected at different intervals between July and September 2021. A total of 40 (66.7%) P. aeruginosa were isolated from the analyzed sewage samples. The highest (2.84x104) pseudomonad count was recorded from sewage samples collected from Kadangaru. Pseudomonas aeruginosa isolates from this sample site showed the highest (100%) resistance to cephalosporins (cefuroxime) and nitrofurantoin. Similarly, isolates from Miami area also demonstrated the highest (95%) resistance to a cephalosporin (ceftazidime). All (100%) isolates used in this study showed MDR resistance to tested antibiotics. The occurrence of MDR P. aeruginosa from a residential sewage site that may contaminate drinking water sources in the study area is of public health threat to the inhabitants. Surveillance and molecular epidemiology of antibiotics resistant bacteria are urgently needed in the study area.

Identification Des Nouveaux Progrès Sur Les Molécules Dérivées Du Pyrazole Comme AgentsAntimicrobiens Et Antifongiques

Microbial infections remain a worldwide leading cause of death,despite the evolution of a large number of new antibiotics everyyear. Currently, several bacteria have developed resistanceagainst antibiotics drugs which remain a major issue inantibiotics drug discovery. This review provides detailedinformation about antimicrobial and antifungal agent synthesisbelonging to the pyrazoles scaffold. We reassemble the resultsobtained from several studies to characterize the importance ofheteroatom nuclei in many synthetic products. Additionally,several compounds based on pyrazole derivatives such asbenzimidazole, benzothiazole, indole, acridine, oxadiazole,imidazole, isoxazole, pyrazole, triazole, quinoline and quinazolineincluding other pyrazole containing drugs such as pyridazine,pyridine and pyrimidine are highlighted. Furthermore, you willfind in this review 134 best promise structures collected fromrecent studies, relating the pyrazoles structures to the relevantbiological activities, in particular, antimicrobial and antifungalone.

Insight into DNA Gyrase inhibition using quantitative structure-Activity relationships and structure-based drug design approaches

The emergence of certain bacterial strains resistant to antibiotics has become a major public health problem, hence the need to develop new antibiotic molecules. Bacterial DNA gyrase, a type II DNA topoisomerase found in all bacteria is a proven target for antibacterial chemotherapy. Our objective is designing novel DNA Gyrase inhibitors using Quantitative StructureActivity Relationships and Structure-Based Drug Design Approaches. We used bioinformatics tools, biological databases like PDB (Protein DataBank), Binding Databases and software's like, MarvinView, MarvinSketch, PyMOL, AutoDockTools-1.5.6. The 3D crystal structure of DNA Gyrase was extracted from PDB (code: 4DHU) and we characterized the active site. Using 83 compounds with different Ki were extracted from Binding Databases, we built and validated a QSAR Model (PLS regression) and we confirmed the interesting correlation between predicted and experimental Ki (R2=0,843). Four molecules were chosen to be docked into DNA Gyrase active site using AutoDockTools. The compound which has the low Ki (Benzimidazole urea analogue 5) shows more binding affinity with score value of ΔG= -8,6 kcal/mol than the others compounds. So, it would be very interesting to synthesis this promising compound and to test in vitro its antibacterial properties.

Helicobacter Pylori Treatment Eradication in Egypt: Standard Clarithromycin-based Triple versus Quadruple Regimen Therapy

Absence of adequate treatment for Helicobacter pylori (H. pylori) infection leads to prolonged life time colonization which is responsible for complications. Antibiotics resistance is the main cause of eradication failure in H. pylori infection, thus our study aimed to evaluate the efficiency and tolerability of standard triple therapy vs. quadruple regimen therapy in H. pylori eradication in Egypt.

In vitro antibiotic susceptibility of bacterial pathogens and risk factors associated with culture positive neonatal sepsis in two hospitals, Katsina metropolis, Nigeria

Background: Neonatal sepsis is one of the most important causes of morbidity and mortality among neonates, particularly in developing countries. This study aimed to determine the risk factors and in vitro antibiotic susceptibility patterns of bacterial pathogens associated with neonatal sepsis in Federal Medical Centre (FMC) and Turai Umaru Yar'adua Maternal and Children Hospital (TUYMCH), Katsina, Nigeria. Methodology: A total of 60 hospitalized neonates evaluated for neonatal sepsis at the special care baby units (SCBU) of the two healthcare facilities whose parents gave informed consent were enrolled for the study between July and December 2020. Blood samples were aseptically collected from the neonates and cultured on BacT/Alert automated platform (BioMérieux, Mercy-Etoile, France) machine. Bacteria were identified from all positive cultures and in vitro susceptibility test was performed on the isolates to determine their minimum inhibitory concentrations (MICs) to eight selected antibiotics using the Vitek-2 compact system. Data were analyzed by SPSS version 22.0. Results: A total of 60 neonates with clinical features suggestive of sepsis were enrolled. The mean age of the neonates is 1.35±0.48 days while the mean weight is 2.13±0.89 kg. Neonates with early onset sepsis (<3 days) constituted 65% while those with late-onset sepsis (>3 days) constituted 35%. Thirty-one (51.7%) neonates were culture positive while 29 (48.3%) were culture negative for bacterial pathogens. Gram-positive bacteria predominated, constituting 80.6% while Gram-negative bacteria constituted 19.4%. The most frequent Gram-positive bacteria were coagulasenegative staphylococci (51.6%, 16/31), with Staphylococcus haemolyticus 5 (16.1%) predominating, while the most frequent Gram-negative bacteria isolate was Escherichia coli 2 (6.5%). A high degree of antibiotic resistance (>50% rate) was exhibited by the isolates against most of the tested antibiotics including third generation cephalosporins and fluoroquinolones. Gentamicin was the only antibiotic effective, with 65.5% of all isolates sensitive to it; 68.0% Gram-positives and 50.0% Gram-negatives. Vancomycin was also effective against Gram-positive bacteria, with 68.0% of the isolates sensitive to it. Previous premature delivery (64.5%, 20/31) and baby delivery at home were respectively the only maternal and neonatal factors significantly associated with culture-positive neonatal sepsis (OR=2.975, 95% CI=1.040-8.510). There was no significant difference between culture positive and negative neonatal sepsis with respect to clinical manifestations such as refusal of feeds, fever, jaundice, fast breathing, convulsion and body temperature (p>0.05). Conclusion: Neonatal sepsis is a substantial cause of mortality and morbidity among neonates admitted at the FMC and TUYMCH, Katsina, Nigeria. There is a need for regular surveillance of the risk factors, causative organisms, and antibiotic susceptibility patterns of isolated pathogens, to inform the choice of empirical antibiotic treatment pending the results of blood cultures

The efficacy of two doses versus 7 days' course of prophylactic antibiotics following cesarean section: An experience from Aminu Kano Teaching Hospital

Postcesarean wound infection is a leading cause of prolonged hospital stay. Considerable debates still exist regarding choice of antibiotics, dose, and duration of use. Objectives: The objective is to compare the efficacy of 2 doses of amoxicillin-clavulanic acid versus a 7 days combination of amoxicillin-clavulanic acid and metronidazole as prophylactic antibiotics following cesarean section (CS). Methodology: It was a randomized controlled trial that was conducted among 160 women undergoing CS at Aminu Kano Teaching Hospital. Women were randomized into two groups. Group I (study group) received 2 doses of 1.2 g amoxicillin-clavulanic acid. Group II (control group) received a 7 days course of amoxicillin-clavulanic acid and metronidazole. The data obtained were analyzed using SPSS version 17. Categorical (qualitative) variables were analyzed using Chi-square test and Fisher's exact test as appropriate while continuous (quantitative) variables were analyzed using independent sample t-test. P < 0.05 was considered statistically significant. Results: There was no statistically significant association in the occurrence of fever (12.8% vs. 15.8%, P = 0.6), wound infection (6.4% vs. 10.5%, P = 0.36), endometritis (7.7% vs. 11.8%, P = 0.38), UTI (6.4% vs. 5.3%, P = 1.00), mean duration of hospital stay (129.7 vs. 134.2 h, P = 0.48), and neonatal outcomes between the two groups. There was statistically significant difference in the mean cost of antibiotics (₦2883/US$9.5 vs. ₦7040/US$23.1, P < 0.001) and maternal side effects (10.3% vs. 26.3%, P < 0.001) between the study and the control groups, respectively. Conclusion: This study found no statistically significant difference in infectious morbidity, duration of hospital stay, and neonatal outcomes when two doses of amoxicillin-clavulanic acid was compared with a 7 days course of prophylactic antibiotic following CS. The use of two doses of amoxicillin-clavulanic acid has the advantages of reduced cost and some maternal side effects. The two doses were cheaper with minimal side effects

Anti-Helicobacter pylori activity of Egyptian medicinal plants and bacteriophages

Background: Helicobacter pylori (H. pylori) is the most common cause of gastric infections worldwide. Due to antibiotic resistance and adverse effects, phytotherapy and phage therapy have been a research focus as an alternative therapy for H. pylori infection. Objectives: To assess the medicinal plant extracts and bacteriophages as a treatment of H. pylori infection. Methodology: Thirty five gastric biopsies were cultured for H. pylori isolation. Screening of medicinal plants extract efficiency was done by Disc diffusion method. Minimum inhibitory concentrations of extracts were assessed. In vivo effect of Punica granatum peel extract was tested by bacterial density and histopathology in rats. Sewage water samples were screened for H. pylori specific bacteriophages. Single plaque isolation technique was used for phage purification. Results: Ten out of 35 (28.57%) patients had positive gastric biopsy for H. pylori by culture. Four out of 10 (40%) isolates were resistant to all antibiotics. Inhibitory effect of Rosemarinus officinalis, Syzygium aromaticum, Rhus coriaria and Ammi visagna on H. pylori was detected. Punica granatum extract was the most efficient in vitro. In vivo, Punica granatum peel extract caused significant reduction of bacterial density (Pty (P<0.05) and enhanced ulcer healing. Sewage water filtrates contained 3 types ofH. pylorispecific bacteriophages. During phagepurification,phage infectivity waslost.Conclusions:Punicagranatumpeel extract revealed better in vivo activity againstH. pylorithanv standard regimen antimicrobials. Other effective plants can be beneficial inH. Pylori infection management .Loss of bacteriophage infectivity may be an obstacle to phage therapy of H. pylori

Evaluation des bonnes pratiques de sondage vésical à demeure chez l'adulte par les soignants: utilisation de « vignettes cliniques »

Introduction. Le sondage urinaire ou vésical est une technique utilisée depuis l'antiquité qui repose sur l'utilisation de dispositifs médicaux invasifs pour le patient. Cet acte de soin doit se faire de façon sécurisée et s'appuyer sur des référentiels. Les objectifs ont été l'évaluation durespect des recommandations du protocole institutionnel sur la pose d'une sonde urinaire à demeure chez l'adulte, le respect del'hygiène et de l'asepsie et l'évaluation des conduites à tenir lors d'une fuite urinaire sur sonde.Matériel et méthodes. Dans le cadre d'une démarche d'évaluation des pratiques professionnelles, une enquête prospective basée sur le concept des « vignettes cliniques » a été menée, avec des mises en situations des soignants du CHU Charles Nicolle, Bois-Guillaume et Oissel en 2011.Résultats. L'enquête révèle un suivi des recommandations sur certains points comme le respect de l'asepsie et du système clos. Des divergences ont été mises en évidence concernant notamment l'usage de la bandelette urinaire chez le patient sondé, le choix du type de sonde et les couples de produits à utiliser pour la détersion et l'antisepsie.Conclusion. Des axes d'améliorations sont proposés comme la sensibilisation des équipes soignantes mais également médicales par le biais notamment d'une plaquette simple et illustrée de support d'information sur les bonnes pratiques de sondage vésical à demeure chez l'adulte et des kits «prêts à l'emploi » de produits pour la détersion et l'antisepsie

Outpatient prescribing and antibiotic use for children in a tertiary hospital

Background: Rational prescribing is essential to prevent medication errors, antibiotic resistance, and treatment failure. Assessment of prescribing practices helps monitor the utilization of medicines. Objectives: The aim of this study was to evaluate the prescribing pattern and utilization of antibiotics for children attending outpatient units. Materials and Methods: This was a descriptive, retrospective study of outpatient pediatric prescriptions received at the pharmacy of a Nigerian teaching hospital, using the World Health Organization (WHO) core prescribing indicators and Index of Rational Drug Prescribing (IRDP). Prescription information for a 2­year period was collected on a standardized prescribing form. Computer data entry was made into Microsoft Excel 2010 spreadsheet. Data analysis was done using SPSS Version 20 (IBM, Corp., Armonk, NY, USA). Results were compared with the WHO core prescribing indicators and presented as means, frequencies, proportions, contingency tables, and charts comparing with published standards. Results: There were 3445 eligible prescriptions, with mean child age of 3.2 (±2.9) years. An average of 2.4 (±1.6) drugs were prescribed per encounter, with 48.2% written in generic names. Prescriptions containing oral antibiotics and antibiotic injections constituted 50.2% and 41.2%, respectively. Medicines prescribed were available in the essential medicines list in 95.5% of cases. The IRDP was 2.98 against the ideal of 5. Majority (71.3%) of antibiotic­containing prescriptions had one antibiotic prescribed while ß­lactam penicillins and cephalosporins were the most prescribed, with ampicillin/cloxacillin being the most common combination. Conclusion: Irrational prescribing and inappropriate antibiotic use were prevalent in this tertiary hospital. Similar studies are needed to describe the trends in all Nigerian tertiary hospitals, along with retraining on rational prescribing

Prise en charge des infections materno-fœtales bactériennes dans le service de néonatologie de l'Hôpital Mère Enfant de N'Djamena au Tchad

Introduction : les décès des nouveau-nés demeurent encore un problème majeur de santé en Afrique malgré les ressources déployées. Le diagnostic des infections bactériennes materno-fœtales semble être souvent fait en excès avec un usage abusif des antibiotiques. L'objectif de l'étude était d'analyser les critères de diagnostic des infections materno-fœtales bactériennes et d'apprécier l'usage abusif des antibiotiques. Patients et méthodes : il s'agissait d'une enquête descriptive réalisée dans le service de Néonatologie de l'hôpital de la Mère et de l'Enfant de Ndjamena et basée sur l'étude des dossiers de tous les nouveau-nés hospitalisés au cours de la période du 1er Janvier au 30 Avril 2019 avec un âge inférieur à 72 heures de vie à l'admission, diagnostiqués pour une infection materno-fœtale et ayant reçu une antibiothérapie pendant au moins 48 heures. L'antibiothérapie a été considérée comme abusive si elle n'avait pas été arrêtée à la 48ème heure, en l'absence de tout argument biologique en faveur d'une infection materno-fœtale bactérienne. Résultats : Sur 404 nouveau-nés hospitalisés au cours de la période d'étude, 170 étaient retenus pour infection maternofœtale soit une fréquence de 42%. En se basant sur les critères rigoureusement définis d'infection néonatale certaine, d'infection néonatale probable ou pas d'infection néonatale, la fréquence était de 16,3% avec 1 cas d'infection certaine et 65 cas d'infection probable. Les nouveau-nés prématurés représentaient 24,2% du lot. Les détresses respiratoires et les signes neurologiques étaient les principales manifestations cliniques à l'admission. Tous les nouveau-nés avaient reçu comme antibiotiques Céfotaxime et Gentamycine. L'évolution s'était faite vers le décès dans 19,7% des cas et chez 62,5% des nouveau-nés prématurés. Le point de l'antibiothérapie à 48 heures d'hospitalisation a été faite chez 15,3% des nouveau-nés. L'usage des antibiotiques n'était pas justifié et était considéré comme abusif chez les 104 nouveau-nés ne présentant pas une infection soit 25% des admissions du service. Conclusion : La fréquence des infections materno-fœtales était surestimée à 42% dans le service de néonatologie de Ndjamena avec un taux d'usage abusif des antibiotiques de 25%. Cela amène à suggérer le renforcement des capacités sur la prévention des infections en maternité et une meilleure application des recommandations de l'Agence nationale d'accréditation et d'évaluation en santé

Effect of physical stresses on survivability and post-exposure antibiotic susceptibility of coliforms in environmental waters and wastewaters

Background: Coliform bacteria are majorly introduced into water bodies (river and wastewater) as a result of faecal pollution, agricultural run-offs and several anthropogenic activities. Despite the effectiveness of water treatment methods, pathogens still persist in water; hence the relevance of assessing the ability of these pathogens to survive the lethal actions of physical stresses and the possible impact on antibiotic susceptibility pattern of the organisms. Methodology: The survivability of Escherichia coli strains (NCM3722, FAP1 and ST2747), Enterobacter cloacae GGT036 and Shigella sonnei 53G was assessed in environmental and waste waters for 21 days. The effect of three treatment regimens (UV radiation, solar radiation and boiling) on the survival of the coliforms was evaluated. Also, the antibiogram of the isolates post­UV exposure was assayed. Results: Although there was significant reduction (≥ 3-log) in the population of the bacteria overtime, all the coliforms survived in the waters for 21 days. The effect of UV radiation was significant on all organisms (> 3 log reductions). Solar radiation for 60 minutes had significantly lesser effect than boiling for 15 minutes. Surviving cells of all isolates demonstrated multiple drug-resistance post exposure to UV radiation. Conclusion: This study revealed the ability of coliforms to persist in waters after treatment and proves that UV radiation may not be effective in attenuation of antibiotic resistance

Assessment of self-medication practices with antibiotics among undergraduate university students in Rwanda

Introduction: antimicrobial Resistance (AR) is on a rise as one of the major global public health threats. It is therefore important to assess contributory factors to the rise in the cases of resistance reported. The main objective of this study was to assess the nself-medication practices with antibiotics among the University of Rwanda students in Huye Campus.Methods: a sample of 570 students from all levels and colleges of the University of Rwanda in Huye Campus were selected using a simple random sampling to participate in this study. A questionnaire was administered to be answered individually by the consented respondents where the self-medication practices with antibiotics in the past 6 months were assessed. The results were statistically analyzed using SPSS v.16.Results: the study showed that 12.1% (n=69) practiced self-medication with antibiotics. The major reason for self medication with antibiotics was illness not serious to have a consultation (50.72%). The main diseases being treated were common cold/fever/cough (47.83%). The antibiotic that was mostly used was Amoxicillin capsules (59.42%), while the main source of antibiotics was community pharmacy (72.42%).Conclusion: the prevalence of self medication is considerably high among university students. Regarding the main reasons of self-medication with antibiotics, diseases being treated, and the antibiotics used, it was found that all these may be related to the students' lack of knowledge about the need for rational use of antibiotics and a study was needed to confirm it

Factors underlying the changing of antibiotics in a paediatric intensive care unit in Pietermaritzburg, KwaZulu-Natal

Background. Antibiotics are among the most commonly used drugs in a paediatric intensive care unit (PICU). Despite guidelines and protocols for the use of antibiotics, inappropriate use may contribute to an increase in antibiotic resistance. The factors behind changes in antibiotic prescriptions in the PICU at Grey's Hospital are unknown. Objective. To establish the frequency, process and rationale behind antibiotic prescription changes in the picu. Methods. A retrospective descriptive study of all eligible patients admitted to the PICU during a 6-month period.Results. Three-quarters of patients admitted to the PICU received antibiotics during their stay. The ofantibiotic prescription was changed in 80 (58%) of the138 patients, with most changes (63.4%) occurring within 3 days of admission. Patients younger than 1 year and those who were malnourished accounted for 57% of the changes. The majority (65%) of the changes entailed the escalation of antibiotics and 89% of these were empiric therapy. De-escalation accounted for 35% of the changes. The rationale for a prescription change was not documented in 80% of cases.Conclusion. Antibiotic use in this PICU and changes to prescriptions were common. Changes were generally made on an empirical basis soon after admission and were more likely to occur in young malnourished children and patients admitted for a medical reason or surgical emergency

Opportunities to optimise colistin stewardship in hospitalised patients in South Africa: Results of a multisite utilisation audit

Background. Colistin is an old antibiotic that has been reintroduced as salvage therapy in hospitalised patients because it is frequently the only agent active against Gram-negative bacteria. Various guidelines for colistin administration have led to confusion in establishing the appropriate dose, which has potential for adverse consequences including treatment failure or toxicity. The emergence and spread of colistin resistance has been documented in South Africa (SA), but no local information exists on how and why colistin is used in hospitals, and similarly, compliance with current dosing guidelines is unknown.Objectives. To evaluate the current utilisation of colistin in SA hospitals, in order to identify stewardship opportunities that could enhance the appropriate use of this antibiotic.Methods. Electronic patient records of adult patients on intravenous (IV) colistin therapy for >72 hours in four private hospitals were retrospectively audited over a 10-month period (1 September 2015 - 30 June 2016). The following data were recorded: patient demographics, culture and susceptibility profiles, diagnosis, and indication for use. Compliance with six colistin process measures was audited: obtaining a culture prior to initiation, administration of a loading dose, administration of the correct loading dose, adjustments to maintenance dose according to renal function, whether colistin was administered in combination with another antibiotic, and whether de-escalation following culture and sensitivity results occurred. Outcome measures included effects on renal function, overall hospital mortality, intensive care unit length of stay (LoS), and hospital LoS.Results. Records of 199 patients on IV colistin were reviewed. There was 99.0% compliance with obtaining a culture prior to antibiotic therapy, 93.5% compliance with prescription of a loading dose, and 98.5% compliance regarding prescription of colistin in combination with another agent. However, overall composite compliance with the six colistin stewardship process measures was 82.0%. Non-compliance related to inappropriate loading and maintenance doses, lack of adjustment according to renal function and lack of de-escalation following culture sensitivity was evident. Significantly shorter durations of treatment were noted in patients who received higher loading doses (p=0.040) and in those who received maintenance doses of 4.5 MU twice daily v. 3 MU three times daily (p=0.0027). In addition, compared with patients who survived, more patients who died received the 3 MU three times daily maintenance dose (p=0.0037; phi coefficient 0.26).Conclusions. The study identified multiple stewardship opportunities to optimise colistin therapy in hospitalised patients. Urgent implementation of a stewardship bundle to improve colistin utilisation is warranted