Antibiotic prescribing patterns at a leading referral hospital in Kenya: a point prevalence survey

Objective: Antibiotics are essential with inappropriate use leading to antimicrobial resistance (AMR). Currently, little is known about antibiotic use among hospitals in Kenya, which is essential to address as part of the recent national action plan to address rising AMR rates. Consequently, the objective was to address this gap in a leading referral hospital in Kenya. The findings will subsequently be used to develop quality improvement programmes for this and other hospitals in Kenya. Methods: A point prevalence survey. Data on antibiotic use was abstracted from patient medical records by a pharmacy team. Findings: Prevalence of antibiotic prescribing was 54.7%, highest in the ICU and isolation wards. Most antibiotics were for treatment (75.4%) rather than prophylaxis (29.0%). The majority of patients on surgical prophylaxis were on prolonged duration (>1 day), with only 9.6% on a single dose as per current guidelines. Penicillins (46.9%) followed by cephalosporins (44.7%) were the most prescribed antibiotic classes. The indication for antibiotic use was documented in only 37.3% of encounters. Generic prescribing was 62.5%, and empiric prescribing in 82.6% of encounters. Guideline compliance was 45.8%. Conclusion: Several areas for improvement were identified including assessing prolonged duration for prophylaxis, extensive prescribing of broad spectrum antibiotics, high prevalence of empiric prescribing and lack of documenting the indication. Initiatives are ongoing to address this with pharmacists playing a key role.