期刊
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
卷 71, 期 6, 页码 1697-1706出版社
OXFORD UNIV PRESS
DOI: 10.1093/jac/dkw025
关键词
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资金
- Training Health Researchers into Vocational Excellence (THRiVE) in East Africa [087540]
- Wellcome Trust
- African Doctoral Dissertation Research Fellowship (ADDRF) award by African Population and Health Research Centre (APHRC) [ADF 006]
- International Development Research Centre (IDRC)
- Medical Research Council [MC_U105260794]
- Medical Research Council [MC_U105260794] Funding Source: researchfish
- MRC [MC_U105260794] Funding Source: UKRI
Objectives: To describe the patterns of systemic antibiotic use and missed-dose days and detail the prescription, dispensing and administration of frequently used hospital-initiated antibiotics among Ugandan inpatients. Methods: This was a prospective cohort of consented adult inpatients admitted on the medical and gynaecological wards of the 1790 bed Mulago National Referral Hospital. Results: Overall, 79% (603/762; 95% CI: 76%-82%) of inpatients received at Least one antibiotic during hospitalization while 39% (300/762; 95% CI: 36%-43%) had used at Least one antibiotic in the 4 weeks pre-admission; 1985 antibiotic DDDs, half administered parenterally, were consumed in 3741 inpatient-days. Two-fifths of inpatients who received at Least one of the five frequently used hospital-initiated antibiotics (ceftriaxone, metronidazole, ciprofloxacin, amoxicillin and azithromycin) missed at Least one antibiotic dose-day (44%, 243/558). The per-day risk of missed antibiotic administration was greatest on day 1: ceftriaxone (36%, 143/398), metronidazole (27%, 67/245), ciprofloxacin (34%, 39/114) and all inpatients who missed at Least one dose-day of prescribed amoxicillin and azithromycin. Most patients received fewer doses than were prescribed: ceftriaxone (74%, 273/371), ciprofloxacin (90%, 94/105) and metronidazole (97%, 222/230). Of prescribed doses, only 62% of ceftriaxone doses (1178/1895), 35% of ciprofloxacin doses (396/1130) and 27% of metronidazole doses (1043/3862) were administered. Seven percent (13/188) of patients on intravenous metronidazole and 6% (5/87) on intravenous ciprofloxacin switched to oral route. Conclusions: High rates of antibiotic use both pre-admission and during hospitalization were observed, with Low parenteral/oral switch of hospital-initiated antibiotics. Underadministration of prescribed antibiotics was common, especially on the day of prescription, risking Loss of efficacy and antibiotic resistance.
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