Patterns of Antibiotic Use in a Rural Tanzanian Clinic
Purpose: Medical practice in developing countries presents numerous challenges that could impact patient care, including education of providers and availability of medical equipment and medications. An area of particular importance is the use of antibiotic medications, where overuse or under-prescribing could lead to patient harm or antibiotic resistance. The purpose of this study was to evaluate the use of common antibiotics in a limited-resource clinic in rural Tanzania in order to identify needs for increased education about the proper use of antibiotics.
Methods: This study was conducted in a small non-profit clinic in the village of Ipalamwa, Tanzania. The study was approved by the clinic and by the St. John Fisher College Institutional Review Board. Data regarding antibiotic prescriptions was collected from the dispensing records of the clinic pharmacy. The medications chosen for analyses were those with the highest levels of use at the clinic, and included: amoxicillin (250mg, 500mg and 125mg/5mL), azithromycin (250mg and 500mg), ampicillin/cloxacillin (250mg/250mg) and ciprofloxacin (500mg). Records were available from two time periods, representing the first 3 months of clinic operation in late 2018, and the most recent 6 months of operation. This allowed for changes in use over time to be analyzed. Data collected for each medication included number of patients per week receiving the medication, number of units dispensed per week and number of units dispensed per patient. Average values were calculated for all raw data points. Additionally, changes in mediation use were graphed over time to look for changes in prescribing patterns. Finally, in order to evaluate the appropriateness of dose and duration of therapy, the most common quantities dispensed per patient were evaluated and compared to standard dosing regimens. In addition to medication dispensing data, records for total number of patients seen and total number of prescriptions filled at the clinic were collected.
Results: During the study period, an average of 103.3 patients per week were seen at the clinic. Almost all patients received a medication from the pharmacy, with an average of 101.7 pharmacy patients per week. On average, each patient received 2.8 prescriptions. The most commonly prescribed antibiotics were determined based on the average number of patients receiving the drug per week: amoxicillin (16.4 patients per week), azithromycin (9.4), ampicillin/cloxacillin (6.9) and ciprofloxacin (13.9). Over time, changes in total use of each medication were observed. Use of all antibiotics on formulary during both analyzed time frames decreased: amoxicillin 250mg (8.2 to 5.3% patients receiving the drug), amoxicillin 500mg (15.8 to 3.7%), amoxicillin 125mg/5mL (13.7 to 6.6%), azithromycin 250mg (17.1 to 5.8%) and ciprofloxacin 500mg (19.5 to 13.9%). Prescription quantities were sporadic and involved vastly different treatment regimens for different patients. For example, amoxicillin 250mg prescriptions ranged from 7.5 to 84 tablets, with a total of 13 different dispensing quantities observed. Similarly, for azithromycin 250mg, prescriptions ranged from 1 to 36 tablets, with a total of 25 different dispensing quantities. Similar patterns were observed for each of the antibiotics and dosages evaluated.
Conclusions: Patterns of antibiotic use in the clinic indicate that opportunities exist to improve the appropriateness of dosing regimens. Specifically, incomplete regimens and abnormally long durations of therapy were observed for all medications evaluated. This could lead to sub-therapeutic treatment of patients or the development of drug-resistant bacteria in the community. To improve community outcomes, the results of this study will serve as a basis for educational programming and creation of treatment protocols in the clinic.
Lull, Melinda E. and Cohan, Dana, "Patterns of Antibiotic Use in a Rural Tanzanian Clinic" (2019). Pharmacy Faculty/Staff Publications. Paper 514.
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Presented at American Society of Health Systems Pharmacy Midyear Clinical Meeting, Las Vegas, Nevada, December 2019.