Evaluation of Antibiotic Utilization in Surgical Ward of University of Gondar Teaching Hospital, Northwest Ethiopia

Abstract

Background: The use of antibiotics in surgical patients for both the prophylaxis and treatment of infections is a reasonable practice; however characterized by unsuitable practices such as unnecessary use for prolonged duration, use of broad-spectrum antibiotics and administering at wrong time. Following this, emergence of resistance, adverse drug reactions and increase cost of health care are major outcomes of inappropriate antibiotic use. Hence, studying the evaluation of antibiotics usage is therefore a helpful technique to improve the appropriateness of antibiotics use. Objective: to evaluate the antibiotics utilization in surgical ward of University of Gondar teaching hospital, Northwest Ethiopia Patients and Method: Hospital based cross sectional study was conducted in surgical wards of University of Gondar Teaching Hospital from March11- May10, 2013 and data were collected by using pre tested standard data collection form, face-to-face interview and observation. Subsequently, the appropriateness of the antibiotics usage was evaluated using Ethiopian standard treatment guideline for general hospital and American Society of Health System Pharmacists, 2010 guideline and surgery lecture note for health officers students for Ethiopia 2004. Descriptive statistics, bivariate analysis and multivariable logistic regression tests were analyzed by using SPSS version 20.0. Result: A total 271 patients medical records were evaluated of whom 211(77.9 %) were for prophylaxis and 60(22.1%) for therapy. 163 prophylactic and 59 therapeutic prescriptions included in the analysis, of these 160(98.2%) of prophylactic and 43 (72.9%) therapeutic prescriptions were inappropriate. The most common reason of inappropriate therapeutic antibiotics included: inappropriate indication, choice, dose and duration of antibiotics were 1 (1.7%); 38 (64.4%); 38 (64.4%); and 43(72.9%) respectively. Moreover, most characteristics of inappropriate prophylaxis were inappropriate indication; choice, dose, duration and starting time of antibiotics were 45(24.2%), 160(98.2%), 121(74.2%), 128(78.5%) and 76(46.4%) respectively. Female patients were 3.998 times more likely received ii inappropriately antibiotics as compared to those males (AOR 95%CI 3.998(1.022- 15.642). The inappropriate usage of antibiotics in emergency surgical procedure 94(97.9%) was higher than elective procedure 107 (86.5%), (AOR 95% CI= 6.395(1.363-29.992), P=0.019). Empirical prescriptions were inappropriate 93% than prescriptions based on available laboratory results 50%, (AOR 95% CI=8.090(1.420-46.078, P=0.019). Unavailability of antibiotics were 5.435 times more likely inappropriate than antibiotics available at the time of prescriptions, (AOR 95%CI=5.435(1.094-27.022, P=0.038). Conclusion and recommendations: Significant amounts of antibiotics were prescribed inappropriately in surgical ward of university of Gondar teaching hospital. To improve appropriate use, ensure availability of antibiotics, encouraging prescribers to use laboratory investigation for prescribing, provision of continuous education and escalation of short-term training of prescribers for appropriate use of antibiotics and preparation of surgical specific evidence-based protocols, guidelines, should be taken into consideration.