'Prospective audit with intervention and feedback' as a core antimicrobial stewardship strategy in the paediatrics department of a Nigerian tertiary hospital.

Introduction: Inappropriate use of antibiotics for childhood illnesses, especially for non-bacterial infections, contributes to the development of antimicrobial resistance (AMR). Globally, implementation of antimicrobial stewardship programme (ASP) in all healthcare institutions is a strategic intervention to improve the appropriate use of antibiotics, reduce antimicrobial consumption and tackle AMR. The aim of this study was to evaluate the effect of prospective audit with intervention and feedback as an antimicrobial stewardship strategy on antimicrobial use, evaluate prescribers' response to recommendations and determine the rate of AMR in the Paediatrics Department of the Lagos University Teaching Hospital, Nigeria. Materials and Methods: This was an implementation study of the paediatrics Antimicrobial Stewardship Programme (ASP) over a period of 6 months. It was initiated with a point prevalence survey (PPS) to describe the antimicrobial prescribing patterns and followed by prospective audit with interventions and feedback using an antimicrobial checklist and the existing antimicrobial guidelines in the Paediatrics Department. Results: The antibiotic prescribing prevalence was high (79.9%) at baseline PPS with 139 patients on admission, of which 111 (79.9%) were treated with 202 antibiotic therapies. Over the 6 months of study, 582 patients on 1146 antimicrobial therapies were audited. Compliance with departmental guidelines was 58.1% of the total 1146 prescriptions audited (n = 666), making the antimicrobial prescription inappropriate in 41.9% (n = 480) of therapies. The most recommended intervention for inappropriateness was 'change antibiotics' 48.8% (n = 234), followed by 'stop antibiotics' 26% (n = 125), 'reduce the number of antibiotics' 19.6% (n = 194) and 'de-escalate' 2.4% (n = 11). Agreement with ASP interventions occurred in 193 (40.2%) cases, and the least agreed intervention was 'stop antibiotics' (n = 40, 32%). However, there was a steady increase in compliance rates with ASP interventions over the 6 months of period study, which was statically significant (χ2: 30.005; P = 0.001). Conclusion: ASP prospective audit with intervention and feedback was of significant benefit in improving compliance with antimicrobial guidelines, thereby improving antimicrobial therapy in the Paediatrics Department of LUTH, Nigeria.

An internet-based cross-sectional study on infection control practices and drug use for COVID-19 prevention in Nigerian adults.

Introduction: COVID-19 has affected several millions of people globally and various means have been employed to curb the spread. This nationwide survey investigated adherence to infection control protocols and drug uptake among Nigerian adults. Methods: this was a descriptive cross-sectional survey using an internet-based questionnaire to investigate adherence to infection control practices and drug use among adults, who have been resident in Nigeria for at least 6 months. The data was analyzed using Stata software version 16 with levels of significance at p<0.05. Results: a total of 1235 adults participated in the study. The respondents were aged 18-78 years with a mean age of 36.3 ±11.1 years. Over half (53.0%) of the participants were between 31-50 years. The male to female ratio was 1: 1.45. Majority (92.6%) had a minimum of tertiary educational qualification. One hundred (27.1%) reported a positive test result for COVID-19. A total of 1,204 (97.5%) admitted to wearing of face masks, 1,125 (91.1%) washed hands regularly, 1,142 (92.5%) used hand sanitizers while physical distancing was maintained in 985 (79.8%). A total of 854 (69.2%) were on at least a drug or herbal based therapy. Herbal based remedies were used in 112 (9.1%), supplements in 763 (61.8%), antibiotics in 210 (17%), ivermectin in 205 (16.6%), and antimalarials in 128 (10.4%) participants. Conclusion: adherence to behavioural measures was high among the population, with widespread uptake of supplements, antibiotics, and antimalarial drugs. The high uptake of antibiotics emphasizes the need to step up regulatory policies for antibiotic use.

A prospective study of the effect of antihypertensive medications on the sexual functions of hypertensive adult male patients.

BACKGROUND: The potential for antihypertensive medications to produce deleterious adverse effects on sexual functions among hypertensive adult male patients has been widely reported, such adverse effects may limit drug adherence and compliance. AIM: The aim of this study was to assess the effect of antihypertensive medication use on sexual functions among hypertensive adult male patients. METHODOLOGY: The study was carried out at the outpatient clinic of a Nigerian University Teaching Hospital. A total of one hundred and fifty-nine recruited hypertensive adult male patients that were being managed at the center over a 3-month period between January 2017 and April 2017 participated in the study; provided they satisfied the inclusion and exclusion criteria for enrolment. RESULTS: The respondents were between 30 and 98 years of age, (mean of 59 ± 11.1 years). Blood pressure recorded was during their initial medical diagnosis for hypertension. Systolic blood pressure recorded was between 128 and 194 mmHg (mean of 162 ± 16.4 mmHg), while their diastolic blood pressure was between 78 and 120 mmHg (mean of 95 ± 10.7 mmHg). The highest occurrence of sexual dysfunctions was associated with calcium-channel blockers in 32 (20.1%) patients, followed by diuretics in 27 (17.0%) and, angiotensin-converting enzyme inhibitors in 20 (12.6%) patients. CONCLUSION: Calcium channel blockers caused the highest occurrence of sexual dysfunctions.

Inappropriate drug use in the elderly outpatient population in a West-African metropolitan community
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OBJECTIVE: Most studies investigating drug use patterns in the elderly have evaluated the prescribers' behavior with little focus on the target population who consume the drugs. This is a community-based study to evaluate drug use patterns in the elderly, a special population because of the high risk of adverse drug reactions including drug hypersensitivity syndrome, which is associated with a higher mortality in this population. MATERIALS AND METHODS: A house-to-house survey was carried out, and drug use was determined by interviewing respondents using a questionnaire. The study population included adults aged 60 years and above. RESULTS: A total of 270 respondents were interviewed. The majority (88.1%) had at least one chronic medical disorder. Hypertension was the most common disease. Multimorbidity and polypharmacy were uncommon in this population. Approximately half (46.4%) of the respondents with chronic diseases were either not on treatment (14.5%) or were on inappropriate drugs and/or drug combinations (31.9%). Of these, 5.1% were on potentially inappropriate medications judging from the Beers Criteria. Inappropriate drug combinations observed in this study included an inappropriate drug for the disease diagnosed, inadvertent use of two different brands of the same drug as two drugs, combining two drugs from the same class, or inappropriate drug class combination among hypertensive patients. Aspirin was the most commonly used drug, some hypertensive patients were taking aspirin without being on concomitant antihypertensive drugs. CONCLUSION: Contrary to reports of polypharmacy, inappropriate drug combinations and a high rate of aspirin use were prominent in the population studied.
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Adverse effects of carbamazepine monotherapy among patients in Nigeria: a pilot study and implications.

AIM: Antiepileptic drugs do cause adverse effects, affecting patients' quality of life, adherence and seizures. Consequently, there is a need to study this among Nigerian patients. METHODS: Descriptive cross-sectional study assessing the extent of adverse effects with carbamazepine monotherapy and potential factors. RESULTS: 54 patients (64.3%) reported no adverse effects, while 30 did. The most common adverse effects were memory problems followed by headaches, restlessness, tiredness and depression. Adverse effects were significantly higher in females, with females with low educational levels having significantly higher rates. Dose, co-medications, seizure control and comorbid conditions did not significantly affect adverse effects. CONCLUSION: Perception of adverse effects was common in patients on carbamazepine monotherapy, more common in women than men. Educational status was important in women.

Outcome of the first Medicines Utilization Research in Africa group meeting to promote sustainable and rational medicine use in Africa.

The first Medicines Utilization Research in Africa group workshop and symposium brought researchers together from across Africa to improve their knowledge on drug utilization methodologies as well as exchange ideas. As a result, progress was made on drug utilization research and formulating future strategies to enhance the rational use of medicines in Africa. Anti-infectives were the principal theme for the 1-day symposium following the workshops. This included presentations on the inappropriate use of antibiotics as well as ways to address this. Concerns with adverse drug reactions and adherence to anti-retroviral medicines were also discussed, with poor adherence remaining a challenge. There were also concerns with the underutilization of generics. These discussions resulted in a number of agreed activities before the next conference in 2016.