Pattern and Quality of Antimicrobial Prescribing in a Nigerian Tertiary Hospital: Report of a Longitudinal Surveillance Cautioning on increasing Threats of Antimicrobial Resistance

Abstract

Background: Indiscriminate use of antimicrobials is threatening their effective use owing to resistance. This study aims to describe the pattern and quality of antimicrobials prescribing at the University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria (UITH) using the five-year data from the Global- Point Prevalence Surveillance (G-PPS). Method: G-PPS, a web-based software, was used among inpatients from 2017 to 2022 according to the protocol designed at the University of Antwerp, Belgium. Data collected using the standardised questionnaire were inputted, cleaned and submitted with the software which gives auto-analysed results immediately. Result: A total of 783 patients and 1281 antimicrobial prescriptions were studied. The 5-year mean overall antimicrobial prevalence was 79.8% and 71.6% for Paediatric and Adult patient population respectively. Overall, there were more intravenous prescriptions (75.9%) than other routes. Polypharmacy with multiple antibiotics use for a single diagnosis (57.1%) and patient (57.6%) were prevalent. The “Access” (51.0%) category of antimicrobials were equally often prescribed as the “Watch” (48.2%) with few “Not Recommended” (0.8%). Most prescriptions were empirical. Indication for antibiotics prescription, and the stop/review date were poorly documented. Antimicrobial prescribing guidelines, such as antibiogram, were not available hence the failure of compliance to any guideline. Conclusion: Antimicrobial prevalence in this study was high, and the quality of prescribing was also unsatisfactory. This requires intervention at many levels, focusing on prescribers, hospital administrators, healthcare policy makers and government. Failure of modulating to ensure rational antimicrobial prescribing may constitute a threat of returning to the casualties of the 'Pre- antimicrobial Era'