Compliance to Guidelines in Prescribing Empirical Antibiotics for Individuals with Uncomplicated Urinary Tract Infection in a Primary Health Facility of Ghana, 2019–2021
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Setting
2.2.1. General Setting
2.2.2. Specific Setting
2.2.3. Management of Uncomplicated UTI
2.2.4. Electronic Medical Records
2.3. Study Population and Period
2.4. Data Variables, Collection and Source of Data
2.5. Data Analysis
3. Results
3.1. Socio-Demographic and Clinical Characteristics
3.2. Prescription of Empirical Antibiotic
3.3. Prescription of Empirical Antibiotics as Recommended in STGs (Dose, Frequency and Duration)
3.4. Patient and Prescriber Characteristics Associated with Prescription of Empirical Antibiotics Not as Recommended in the STGs
3.5. Distribution of Prescribed Empirical Antibiotics across the WHO AWaRe Category
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Total | Empirical Antibiotic Use | p Value e | ||
---|---|---|---|---|---|
N | (%) a | n | (%) b | ||
Total | 3717 | (100) | 3073 | (83) | |
Age in years | |||||
18–29 | 757 | (20.4) | 632 | (83.5) | 0.262 |
30–44 | 919 | (24.7) | 775 | (84.3) | |
45–59 | 804 | (21.6) | 661 | (82.2) | |
≥60 | 1237 | (33.3) | 1005 | (81.2) | |
Gender | |||||
Male | 1064 | (28.6) | 878 | (82.5) | 0.874 |
Female | 2653 | (71.4) | 2195 | (82.7) | |
Occupation | |||||
Employed | 1909 | (51.4) | 1577 | (82.6) | 0.993 |
Unemployed | 592 | (15.9) | 489 | (82.6) | |
Student | 320 | (8.6) | 267 | (83.4) | |
Retired | 238 | (6.4) | 195 | (81.9) | |
Not recorded | 658 | (17.7) | 545 | (82.8) | |
NHIS | |||||
Yes | 2920 | (78.6) | 2402 | (82.3) | 0.202 |
No | 797 | (21.4) | 671 | (84.2) | |
Year | |||||
2019 | 644 | (17.3) | 533 | (82.8) | 0.255 |
2020 | 1746 | (47.0) | 1426 | (81.7) | |
2021 | 1327 | (35.7) | 1114 | (84.0) | |
Comorbidities c | |||||
Diabetes Mellitus | 621 | (16.7) | 497 | (80.0) | 0.111 |
Hypertension | 1231 | (33.1) | 1024 | (83.2) | 0.508 |
Urine routine examination | |||||
Not done | 1137 | (30.5) | 979 | (86.1) | 0.001 |
Done | 2574 | (69.3) | 2089 | (81.2) | |
Missing | 6 | (0.2) | 5 | (83.3) | |
Prescriber gender | |||||
Male | 2084 | (56.0) | 1719 | (82.5) | 0.915 |
Female | 1623 | (43.7) | 1346 | (83.0) | |
Missing | 10 | (0.3) | 8 | (80.0) | |
Prescriber rank d | |||||
Physician Assistant | 36 | (1.0) | 27 | (75.5) | 0.570 |
Medical Officer | 1616 | (43.5) | 1349 | (83.5) | |
Senior/Deputy Medical Officer | 348 | (9.4) | 290 | (83.3) | |
Resident | 1136 | (30.6) | 936 | (82.4) | |
Specialist | 578 | (15.6) | 469 | (81.1) | |
Missing |
Characteristics | Total | Empirical Antibiotics not as Recommended in STGs | Unadjusted b | Adjusted c | |||
---|---|---|---|---|---|---|---|
N | n | (%) a | PR | (95% CI) | aPR | (95% CI) | |
Total | 3073 | 1226 | (39.9) | ||||
Age in years | |||||||
18–29 | 632 | 234 | (37.0) | 1 | 1 | ||
30–44 | 775 | 313 | (40.4) | 1.1 | (1.0–1.3) | 1.1 | (1.0–1.2) |
45–59 | 661 | 251 | (38.0) | 1.0 | (0.9–1.2) | 1.0 | (0.9–1.2) |
≥60 | 1005 | 428 | (42.6) | 1.1 | (1.0–1.3) | 1.0 | (0.9–1.2) |
Gender | |||||||
Male | 878 | 819 | (93.3) | 5.0 | (4.6–5.5) | 5.0 | (4.6–5.5) f |
Female | 2195 | 407 | (18.5) | 1 | 1 | ||
Occupation | |||||||
Employed | 1577 | 632 | (40.1) | 0.9 | (0.9–1.1) | 1.0 | (0.8–1.1) |
Unemployed | 489 | 200 | (40.9) | 1 | 1 | ||
Student | 267 | 99 | (37.1) | 0.9 | (0.8–1.1) | 0.9 | (0.8–1.2) |
Retired | 195 | 96 | (49.2) | 1.2 | (1.0–1.5) | 1.0 | (0.8–1.1) |
Not recorded | 545 | 199 | (36.5) | 0.9 | (0.8–1.1) | 0.9 | (0.8–1.0) |
NHIS | |||||||
Yes | 2402 | 938 | (39.1) | 1 | 1 | ||
No | 671 | 288 | (42.9) | 1.1 | (1.0–1.3) | 1.0 | (0.9–1.1) |
Year | |||||||
2019 | 533 | 200 | (37.5) | 1 | 1 | ||
2020 | 1426 | 565 | (39.6) | 1.0 | (0.9–1.2) | 1.0 | (0.9–1.1) |
2021 | 1114 | 461 | (41.4) | 1.1 | (1.0–1.3) | 1.2 | (1.0–1.3) f |
Comorbidities d | |||||||
Diabetes Mellitus | 497 | 197 | (39.6) | 1.0 | (0.8–1.1) | 1.0 | (0.9–1.1) |
Hypertension | 1024 | 412 | (40.2) | 1.0 | (0.9–1.1) | 1.0 | (0.9–1.1) |
Urine routine examination | |||||||
Done | 2089 | 867 | (41.5) | 1 | 1 | ||
Not done | 979 | 356 | (36.4) | 0.9 | (0.8–1.0) | 0.9 | (0.8–1.0) |
Not recorded | 5 | 3 | (60.0) | 1.5 | (0.7–3.3) | 1.3 | (0.7–2.3) |
Prescriber gender | |||||||
Male | 1719 | 708 | (41.2) | 1 | 1 | ||
Female | 1346 | 516 | (38.3) | 0.9 | (0.9–1.0) | 0.9 | (0.9–1.0) |
Missing | 8 | 2 | (25.0) | 0.6 | (0.2–2.0) | 0.5 | (0.1–1.9) |
Prescriber rank e | |||||||
Physician Assistant | 27 | 11 | (40.7) | 0.8 | (0.5–1.3) | 1.0 | (0.6–1.5) |
Medical Officer | 1349 | 545 | (40.4) | 0.9 | (0.8–1.0) | 1.0 | (0.9–1.1) |
Senior/Deputy Medical Officer | 290 | 133 | (46.0) | 1 | 1 | ||
Resident | 936 | 367 | (39.2) | 0.8 | (0.7–1.0) | 1.0 | (0.9–1.1) |
Specialist | 469 | 169 | (36.0) | 0.8 | (0.6–0.9) | 0.9 | (0.7–1.0) |
Missing | 2 | 1 | (50.0) | 0.9 | (0.2–4.3) | 1.3 | (0.4–4.8) |
Antibiotic | N | (%) |
---|---|---|
Total * | 3378 | (100) # |
Access | ||
Tinidazole | 119 | (3.5) |
Nitrofurantoin | 90 | (2.7) |
Doxycycline | 88 | (2.6) |
Amoxicillin/clavulanic acid | 52 | (1.5) |
Secnidazole | 20 | (0.6) |
Metronidazole | 8 | (0.2) |
Clindamycin | 2 | (0.06) |
Amoxicillin | 1 | (0.03) |
Sulfamethoxazole/trimethoprim | 1 | (0.03) |
Watch | ||
Cefuroxime | 1831 | (54.2) |
Ciprofloxacin | 1036 | (30.7) |
Cefixime | 38 | (1.1) |
Ceftriaxone | 33 | (1.0) |
Levofloxacin | 31 | (0.9) |
Azithromycin | 23 | (0.7) |
Cefpodoxime | 3 | (0.1) |
Clarithromycin | 2 | (0.1) |
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Owusu, H.; Thekkur, P.; Ashubwe-Jalemba, J.; Hedidor, G.K.; Corquaye, O.; Aggor, A.; Steele-Dadzie, A.; Ankrah, D. Compliance to Guidelines in Prescribing Empirical Antibiotics for Individuals with Uncomplicated Urinary Tract Infection in a Primary Health Facility of Ghana, 2019–2021. Int. J. Environ. Res. Public Health 2022, 19, 12413. https://doi.org/10.3390/ijerph191912413
Owusu H, Thekkur P, Ashubwe-Jalemba J, Hedidor GK, Corquaye O, Aggor A, Steele-Dadzie A, Ankrah D. Compliance to Guidelines in Prescribing Empirical Antibiotics for Individuals with Uncomplicated Urinary Tract Infection in a Primary Health Facility of Ghana, 2019–2021. International Journal of Environmental Research and Public Health. 2022; 19(19):12413. https://doi.org/10.3390/ijerph191912413
Chicago/Turabian StyleOwusu, Helena, Pruthu Thekkur, Jacklyne Ashubwe-Jalemba, George Kwesi Hedidor, Oksana Corquaye, Asiwome Aggor, Allen Steele-Dadzie, and Daniel Ankrah. 2022. "Compliance to Guidelines in Prescribing Empirical Antibiotics for Individuals with Uncomplicated Urinary Tract Infection in a Primary Health Facility of Ghana, 2019–2021" International Journal of Environmental Research and Public Health 19, no. 19: 12413. https://doi.org/10.3390/ijerph191912413