Antibiotic prescribing patterns among physicians at the University Teaching Hospital in Lusaka, Zambia

Abstract

Background:Prescribing patterns can greatly have a negative impact on patient care outcomes if not underpinned by use of ideal standards and evidence-based medicine. The overall aim of this clinical research was to determine the antibiotic prescribing patterns among physicians and compare compliance of antibiotic prescribing with adopted National treatment guidelines.Methods :A cross-sectional study was undertaken which involved reviewing of patients’ records in wards, administration of a questionnaire to physicians and clinical heads as well as the head of pharmacy department. Systematic sampling was used for selection of patient files. The study was conducted over four months.The study was conducted in the medical wards in the departments of Obstetrics and Gynaecology (OBGY), Internal Medicine (IM) and Surgery at University Teaching Hospital.A sample of 385 patients were selected whose records and charts were reviewed. Of these, 165 were from the department of OBGY, 120 were from IM and 100 were from Surgery. Physicians were sampled using convenience sampling method.Outcome measures were compliance with Gyssens et al. recommendations, Zambian Standard Treatment Guidelines (STG) and Traffic-light system. Documentation of clinical indication, dose, frequency, route and duration and collection of culture samples before initiation of treatment were used to measure appropriateness of a prescription.Results: Of the 385 study patients evaluated, 270(70.1%) were prescribed with antibiotic(s). Out of 165 study patients from OBGY, 121(73.3%) were prescribed with antibiotic(s); out 120 from IM, 72(60%) were prescribed with antibiotics and those from Surgery, 77(77.0%) out of 100 study patients were prescribed with antibiotics. The average number of antibiotics per prescription was 1.8. The individual departments had prescriptions complying with Gyssens et al. recommendations of 59(24.3%), 18(12.4%) and 20(22.2%) for OBGY, IM and Surgery respectively. Out of 270 study patients who were prescribed with antibiotics, only 86(31.9%) had bacteriological tests ordered and only 27/86(31.4%) had the culture results ready at the time of review. The study has found that the association between position of physician and factors influencing prescribing tendencies was not statistically significant (p=0.084).The association between position held by study physicians and the ordering of bacteriological tests was found to be statistically significant (p=0.001). The study also found that there was only the Drug and Therapeutics Committee (DTC) and no other systems, structures or processes regulating the use of antibiotics at UTH.Conclusion :It can be concluded from the findings of this study that prescribing patterns do not comply with recommended standards of care. Antibiotics were prescribed without bacteriological tests. It can also be concluded that no structures and systems are available to control use of antibiotics at the hospital.