Patterns and contextual determinants of antibiotic prescribing for febrile under-five outpatients at primary and secondary healthcare facilities in Bugisu, Eastern Uganda.

Autor:	Allwell-Brown G; Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, SE-751 85 Uppsala, Sweden., Namugambe JS; Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda., Ssanyu JN; Sustainable Pharmaceutical Systems (SPS) Unit, School of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda.; School of Public Health, Makerere University, PO Box 7072, Kampala, Uganda., Johansson EW; Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, SE-751 85 Uppsala, Sweden., Hussain-Alkhateeb L; Global Health, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-405 30 Gothenburg, Sweden., Strömdahl S; Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden., Mårtensson A; Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, SE-751 85 Uppsala, Sweden., Kitutu FE; Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, SE-751 85 Uppsala, Sweden.; Sustainable Pharmaceutical Systems (SPS) Unit, School of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda.; School of Public Health, Makerere University, PO Box 7072, Kampala, Uganda.
Jazyk:	angličtina
Zdroj:	JAC-antimicrobial resistance [JAC Antimicrob Resist] 2022 Sep 05; Vol. 4 (5), pp. dlac091. Date of Electronic Publication: 2022 Sep 05 (Print Publication: 2022).
DOI:	10.1093/jacamr/dlac091
Abstrakt:	Objectives: To describe patterns and contextual determinants of antibiotic prescribing for febrile under-five outpatients at primary and secondary healthcare facilities across Bugisu, Eastern Uganda. Methods: We surveyed 37 public and private-not-for-profit healthcare facilities and conducted a retrospective review of antimicrobial prescribing patterns among febrile under-five outpatients (with a focus on antibiotics) in 2019-20, based on outpatient registers. Multilevel logistic regression analysis was used to identify determinants of antibiotic prescribing at patient- and healthcare facility-levels. Results: Antibiotics were prescribed for 62.2% of 3471 febrile under-five outpatients. There were a total of 2478 antibiotic prescriptions of 22 antibiotic types: amoxicillin (52.2%), co-trimoxazole (14.7%), metronidazole (6.9%), gentamicin (5.7%), ceftriaxone (5.3%), ampicillin/cloxacillin (3.6%), penicillin (3.1%), and others (8.6%). Acute upper respiratory tract infection (AURTI) was the commonest single indication for antibiotic prescribing, with 76.3% of children having AURTI as their only documented diagnosis receiving antibiotic prescriptions. Only 9.2% of children aged 2-59 months with non-severe pneumonia received antibiotic prescriptions in line with national guidelines. Higher health centre levels, and private-not-for-profit ownership (adjusted OR, 4.30; 95% CI, 1.91-9.72) were significant contextual determinants of antibiotic prescribing. Conclusions: We demonstrated a high antibiotic prescribing prevalence among febrile under-five outpatients in Bugisu, Eastern Uganda, including prescriptions for co-trimoxazole and ampicillin/cloxacillin (which are not indicated in the management of the common causes of under-five febrile illness in Uganda). Study findings may be linked to limited diagnostic capacity and inadequate antibiotic availability, which require prioritization in interventions aimed at improving rational antibiotic prescribing among febrile under-five outpatients. (© The Author(s) 2022. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)
Databáze:	MEDLINE
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