Multicentre point prevalence survey regarding antimicrobial use among community healthcare centres across South Africa

Background: A considerable proportion of antibiotics globally are consumed in ambulatory care especially among low- and middle-income countries; however, there are appreciable knowledge gaps regarding the extent and rationale for their use especially among African countries. Objective: Undertake a point prevalent survey (PPS) among community health centres (CHCs) in South Africa (SA) to address this. Methods: A PPS was undertaken among patients attending 18 randomly selected CHCs in South Africa (2 from each Province). A newly developed web-based application was used to record antibiotic utilisation data given the time taken with paper-based systems, with utilisation assessed against South African and WHO (AWaRe list) guidelines. Results: The prevalence of antimicrobial use was 21.5% (420 of 1958 patients), which included one or more antimicrobials per patient. Amoxicillin (32.9%), isoniazide (11.3%) and a combination of rifampicin, isoniazid, pyrazinamide and ethambutol (Rifafour®) (10.5%) were the most frequently prescribed antibiotics. Encouragingly, most antimicrobials were from the WHO Access list (62.1%) with only 15.0% from the Watch List and none from the Reserve list; however, 22.8% were unclassified. There was high adherence to the SA standard treatment guidelines (93.4%). Ear, nose and throat infections were the most common (22.8%), with no culture results recorded in patients’ files. Conclusions: Encouraging to see high adherence to SA guidelines, with the majority from the WHO Access list. However, concerns with appreciable prescribing of antimicrobials for upper respiratory tract infections and lack of sensitivity testing. Antimicrobial stewardship programmes can help address identified concerns and we will be following this up.