Implementation of a delayed prescribing model to reduce antibiotic prescribing for suspected upper respiratory tract infections in a hospital outpatient department, ghana

Samuel Ghebrehewet, Wendi Shepherd, Edwin Panford-Quainoo, Saran Shantikumar, Valerie Decraene, Rajesh Rajendran, Menaal Kaushal, Afua Akuffo, Dinah Ayerh, George Amofah

Research output: Contribution to journalArticlepeer-review

Abstract

Background: High levels of antimicrobial resistance (AMR) in Ghana require the exploration of new approaches to optimise antimicrobial prescribing. This study aims to establish the feasibility of implementation of different delayed/back-up prescribing models on antimicrobial prescribing for upper respiratory tract infections (URTIs). Methods: This study was part of a quality improvement project at LEKMA Hospital, Ghana, (Dec 2019–Feb 2020). Patients meeting inclusion criteria were assigned to one of four groups (Group 0: No prescription given; Group 1; Patient received post-dated antibiotic prescription; Group 2: Offer of a rapid reassessment of patient by a nurse practitioner after 3 days; and Group 3: Post-dated prescription forwarded to hospital pharmacy). Patients were contacted 10 days afterwards to ascertain wellbeing and actions taken, and patients were asked rate the service on a Likert scale. Post-study informal discussions were conducted with hospital staff. Results: In total, 142 patients met inclusion criteria. Groups 0, 1, 2 and 3 had 61, 16, 44 and 21 patients, respectively. Common diagnosis was sore throat (73%). Only one patient took antibiotics after 3 days. Nearly all (141/142) patients were successfully contacted on day 10, and of these, 102 (72%) rated their experiences as good or very good. Informal discussions with staff revealed improved knowledge of AMR. Conclusions: Delayed/back-up prescribing can reduce antibiotic consumption amongst outpatient department patients with suspected URTIs. Delayed/back-up prescribing can be implemented safely in low and middle-income countries (LMICs).

Original languageEnglish
Article number773
Pages (from-to)1-11
Number of pages11
JournalAntibiotics
Volume9
Issue number11
DOIs
Publication statusPublished - Nov 2020

Keywords

  • Antimicrobial resistance (AMR)
  • Antimicrobial stewardship (AMS)
  • Delayed/back-up prescribing
  • Developing countries
  • Ghana
  • LMICs
  • Upper respiratory tract infections

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