Assessment of the quality of antimicrobial prescribing among hospitalized patients in a teaching hospital in Ghana: findings and implications

Objective: There is a need to assess the quality of antimicrobial prescribing in hospitals as the first step towards improving future prescribing to reduce antimicrobial resistance (AMR). This is in line with the National Action Plan of Ghana. Methods: A point prevalence survey of antimicrobial use was undertaken at the adult medical, surgical and pediatric wards of Tamale Teaching Hospital using the standardized Global Point Prevalence Survey (GPPS) tool. Key target areas include adherence to current guidelines, limiting the prescribing of 'Watch' antibiotics with their greater resistance potential, and limiting the prescribing of antibiotics post-operatively to prevent surgical site infections (SSIs). Results: Out of 217 patient’s medical records assessed, 155 (71.4%) patients were prescribed antimicrobials. The rates were similar among children (73.9%) and adults (70.3 %). Most of the antibiotics prescribed were in the WHO 'Watch' group (71.0%) followed by those in the 'Access' group (29%). Out of the 23 cases indicated for surgical antimicrobial prophylaxis to prevent SSIs, the majority (69.6%) were given doses for more than one day with none receiving a single dose. This needs addressing to reduce AMR and costs. Guideline compliance to the current Ghanaian Standard Treatment Guidelines (GSTG) for managing infections was also low (28.7%). The type of indication was the only independent predictor of guideline compliance (aOR=0.013 CI 0.001 – 0.127, p-value =0.001). Conclusion: Given current concerns with antimicrobial prescribing in this hospital, deliberate efforts must be made to improve the appropriateness of prescribing to reduce AMR via targeted antimicrobial stewardship programs.