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Nsojo A, George L, Mwasomola D, Tawete J, Mbotwa CH, Mweya CN, Mwakyula I. Prescribing patterns of antimicrobials according to the WHO AWaRe classification at a tertiary referral hospital in the southern highlands of Tanzania. Infect Prev Pract 2024; 6:100347. [PMID: 38405014 PMCID: PMC10883815 DOI: 10.1016/j.infpip.2024.100347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/07/2024] [Indexed: 02/27/2024] Open
Abstract
Background Antimicrobial consumption continues to rise globally and contributes to the emergence and spread of antimicrobial resistance. This study aimed to evaluate antimicrobial prescribing patterns in a selected tertiary hospital in Tanzania. Methods This cross-sectional study was conducted for one year (September 2021-September 2022) at Mbeya Zonal Referral Hospital, a public hospital in the southern highlands zone of Tanzania. Data on clinical diagnosis, laboratory tests, prescribed antimicrobials, and prescribers' designations were collected through a custom eMedical system, aligning antimicrobials with the WHO's 2021 AWaRe classification. Descriptive analysis was performed to assess the pattern of antimicrobial prescriptions. Results Of 2,293 antimicrobial prescriptions, 62.41% were ACCESS, 37.42% were WATCH, and 0.17% fell in the RESERVE categories. Metronidazole, accounting for 23.8%, was the most commonly prescribed antimicrobial. More than 50% of the ACCESS and WATCH prescriptions were justified by laboratory diagnosis and were predominantly prescribed by clinicians. A very small proportion of prescriptions (<1%) were informed by culture and sensitivity (C/S) testing. The Paediatric department had the majority of WATCH prescriptions (72.2%). Conclusion The prescribing patterns at the study hospital generally align with WHO AWaRe guidelines, potentially mitigating antimicrobial resistance. Nevertheless, the scarcity of culture and sensitivity testing is a concern that warrants targeted improvement.
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Affiliation(s)
- Anthony Nsojo
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, P. O. Box 608, Mbeya, Tanzania
- Mbeya Zonal Referral Hospital, P. O. Box 419, Mbeya, Tanzania
| | | | | | - Joseph Tawete
- Mbeya Zonal Referral Hospital, P. O. Box 419, Mbeya, Tanzania
| | - Christopher H. Mbotwa
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, P. O. Box 608, Mbeya, Tanzania
| | - Clement N. Mweya
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, P. O. Box 608, Mbeya, Tanzania
- Mbeya Medical Research Centre, National Institute for Medical Research, P. O. Box 2410, Mbeya, Tanzania
| | - Issakwisa Mwakyula
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, P. O. Box 608, Mbeya, Tanzania
- Mbeya Zonal Referral Hospital, P. O. Box 419, Mbeya, Tanzania
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Deogratias G, Shadrack DM, Munissi JJE, Kinunda GA, Jacob FR, Mtei RP, Masalu RJ, Mwakyula I, Kiruri LW, Nyandoro SS. Hydrophobic π-π stacking interactions and hydrogen bonds drive self-aggregation of luteolin in water. J Mol Graph Model 2022; 116:108243. [PMID: 35777224 DOI: 10.1016/j.jmgm.2022.108243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/12/2022] [Accepted: 06/05/2022] [Indexed: 12/14/2022]
Abstract
Luteolin is a flavonoid obtained from different plant species. It is known for its versatile biological activities. However, the beneficial effects of luteolin have been limited to small concentrations as a result of poor water solubility. This study aimed at investigating the hydrophobic interaction and hydration of luteolin towards the improvement of its solubility when used as a drug. We report the aggregation properties of luteolin in water by varying the number of monomers using atomistic molecular dynamics simulation. Results show that the equilibrium structure of luteolin occurs in an aggregated state with different structural arrangements. As the monomers size increase, the antiparallel flipped conformation dominates over T-shaped antiparallel, T-shaped parallel, and antiparallel conformations. The formation of intramolecular hydrogen bonding of 0.19 nm between the keto-enol groups results in hydrophobic characteristics. A larger cluster exhibits slow hydrogen bond dynamics for luteolin-luteolin than luteolin-water interaction. Water structure at large cluster size exhibited slow dynamics and low self-diffusion of luteolin. The existence of hydrophobic π-π and hydrogen bonds between luteolin molecules drives strong self-aggregation resulting in poor water solubility. Breakage of these established interactions would result in increased solubility of luteolin in water.
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Affiliation(s)
- Geradius Deogratias
- Chemistry Department, College of Natural and Applied Sciences, University of Dar es Salaam, P.O. Box 35061, Dar es Salaam, Tanzania.
| | - Daniel M Shadrack
- Department of Chemistry, Faculty of Natural and Applied Sciences, St. John's University of Tanzania, P.O. Box 47, Dodoma, Tanzania
| | - Joan J E Munissi
- Chemistry Department, College of Natural and Applied Sciences, University of Dar es Salaam, P.O. Box 35061, Dar es Salaam, Tanzania
| | - Grace A Kinunda
- Chemistry Department, College of Natural and Applied Sciences, University of Dar es Salaam, P.O. Box 35061, Dar es Salaam, Tanzania
| | - Fortunatus R Jacob
- Chemistry Department, College of Natural and Applied Sciences, University of Dar es Salaam, P.O. Box 35061, Dar es Salaam, Tanzania
| | - Regina P Mtei
- Chemistry Department, College of Natural and Applied Sciences, University of Dar es Salaam, P.O. Box 35061, Dar es Salaam, Tanzania
| | - Rose J Masalu
- Department of Molecular Biology and Biotechnology, College of Natural and Applied Sciences, University of Dar es Salaam, P.O. Box 25179, Dar es Salaam, Tanzania
| | - Issakwisa Mwakyula
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, P.O. Box 608, Mbeya, Tanzania
| | - Lucy W Kiruri
- Department of Chemistry, Kenyatta University, P.O.Box, 43844-00100, Nairobi, Kenya
| | - Stephen S Nyandoro
- Chemistry Department, College of Natural and Applied Sciences, University of Dar es Salaam, P.O. Box 35061, Dar es Salaam, Tanzania
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Mbuya W, Mwakyula I, Olomi W, Agrea P, Nicoli F, Ngatunga C, Mujwahuzi L, Mwanyika P, Chachage M. Altered Lipid Profiles and Vaccine Induced-Humoral Responses in Children Living With HIV on Antiretroviral Therapy in Tanzania. Front Cell Infect Microbiol 2021; 11:721747. [PMID: 34858867 PMCID: PMC8630663 DOI: 10.3389/fcimb.2021.721747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
People living with HIV, even under therapy, have a high burden of age-related co-morbidities including an increased risk of dyslipidemia (which often predisposes to cardiovascular diseases) and immune-aging. In this study, lipid profiles and antibody responses to measles and pertussis toxin vaccines were compared between ART experienced HIV+ children (n=64) aged 5-10 years, and their age- and sex-matched HIV- controls (n=47). Prevalence of high-density lipoprotein cholesterol (HDL-c) and triglyceride-driven dyslipidemia was higher among treated HIV+ children than in controls (51.6% vs 27.7% respectively, p < 0.019). In a multivariate Poisson regression model adjusted for age, sex and BMI, the association between low HDL-c, hypertriglyceridemia and HIV remained significantly high (for HDL-c: ARR: 0.89, 95% CI: 0.82 - 0.96, p = 0.003; for triglycerides: ARR: 1.54, 95% CI: 1.31 - 1.81, p < 0.001). Among HIV+ children, the use of lopinavir/ritonavir, a protease-based antiretroviral therapy was also associated elevation of triglyceride levels (p = 0.032). Also, HIV+ children had a 2.8-fold reduction of anti-measles IgG titers and 17.1-fold reduction of anti-pertussis toxin IgG levels when compared to HIV- children. Our findings suggest that dyslipidemia and inadequate vaccine-induced antibody responses observed in this population of young African HIV+ children might increase their risk for premature onset of cardiovascular illnesses and acquisition of preventable diseases.
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Affiliation(s)
- Wilbert Mbuya
- National Institute for Medical Research (NIMR), Mbeya Medical Research Centre (MMRC), Mbeya, Tanzania
| | - Issakwisa Mwakyula
- Department of Internal Medicine, Mbeya Zonal Referral Hospital and University of Dar es Salaam Mbeya College of Health and Allied Sciences, Mbeya, Tanzania
| | - Willyelimina Olomi
- National Institute for Medical Research (NIMR), Mbeya Medical Research Centre (MMRC), Mbeya, Tanzania
| | - Peter Agrea
- National Institute for Medical Research (NIMR), Mbeya Medical Research Centre (MMRC), Mbeya, Tanzania
| | - Francesco Nicoli
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, Ferrara, Italy
| | - Cecilia Ngatunga
- Department of Radiology, Mbeya Zonal Referral Hospital and University of Dar es Salaam Mbeya College of Health and Allied Sciences, Mbeya, Tanzania
| | - Leodegard Mujwahuzi
- Department of Internal Medicine, Mbeya Zonal Referral Hospital and University of Dar es Salaam Mbeya College of Health and Allied Sciences, Mbeya, Tanzania
| | - Paul Mwanyika
- Department of Paediatric, Mbeya Zonal Referral Hospital and University of Dar es Salaam Mbeya College of Health and Allied Sciences, Mbeya, Tanzania
| | - Mkunde Chachage
- National Institute for Medical Research (NIMR), Mbeya Medical Research Centre (MMRC), Mbeya, Tanzania.,Department of Microbiology and Immunology, University of Dar es Salaam - Mbeya College of Health and Allied Sciences (UDSM-MCHAS), Mbeya, Tanzania
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Hall JW, Bouchard J, Bookstaver PB, Haldeman MS, Kishimbo P, Mbwanji G, Mwakyula I, Mwasomola D, Seddon M, Shaffer M, Shealy SC, Nsojo A. The Mbeya Antimicrobial Stewardship Team: Implementing Antimicrobial Stewardship at a Zonal-Level Hospital in Southern Tanzania. Pharmacy (Basel) 2020; 8:pharmacy8020107. [PMID: 32599699 PMCID: PMC7356184 DOI: 10.3390/pharmacy8020107] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/11/2020] [Accepted: 06/18/2020] [Indexed: 01/14/2023] Open
Abstract
Background: In 2017, Mbeya Zonal Referral Hospital (MZRH) and the University of South Carolina (UofSC) agreed to collaboratively strengthen antimicrobial prescribing in the southern highlands of Tanzania and train a new generation of clinicians in responsible antimicrobial use. Methods: Key stakeholders and participants were identified and the Mbeya Antimicrobial Stewardship Team (MAST) was created. The team identified assets brought by the collaborators, and four investigations of baseline needs were developed. These investigations included (a) a baseline clinician survey regarding antimicrobial resistance and stewardship, (b) a serial chart review of inpatient antimicrobial prescribing practices, (c) an investigation of antimicrobial resistance rates using existing isolates at the MZRH laboratory, and (d) a survey of antimicrobial availability at community pharmacies in the city. Results: 91% of physicians believe antimicrobial resistance is problem in Tanzania, although only 29% of physicians were familiar with the term “antimicrobial stewardship”. Escherichia coli isolates had resistance rates of over 60% to the commonly used agents ciprofloxacin, trimethoprim-sulfamethoxazole, and ceftriaxone. Thirteen out of 14 community pharmacies offered over-the-counter antibiotics for upper respiratory symptoms. Conclusions: International antimicrobial stewardship collaborations can successfully identify opportunities and needs. Evaluating the team’s efforts to improve patient outcomes will be essential.
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Affiliation(s)
- Jeffrey W. Hall
- School of Medicine, University of South Carolina, Columbia, SC 29209 USA; (M.S.H.); (M.S.)
- College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA; (J.B.); (P.B.B.); (S.C.S.)
- Correspondence:
| | - Jeannette Bouchard
- College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA; (J.B.); (P.B.B.); (S.C.S.)
| | - P. Brandon Bookstaver
- College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA; (J.B.); (P.B.B.); (S.C.S.)
| | - Matthew S. Haldeman
- School of Medicine, University of South Carolina, Columbia, SC 29209 USA; (M.S.H.); (M.S.)
| | - Peter Kishimbo
- Mbeya Zonal Referral Hospital, Mbeya PO Box 419, Tanzania; (P.K.); (G.M.); (I.M.); (D.M.); (A.N.)
| | - Godlove Mbwanji
- Mbeya Zonal Referral Hospital, Mbeya PO Box 419, Tanzania; (P.K.); (G.M.); (I.M.); (D.M.); (A.N.)
| | - Issakwisa Mwakyula
- Mbeya Zonal Referral Hospital, Mbeya PO Box 419, Tanzania; (P.K.); (G.M.); (I.M.); (D.M.); (A.N.)
| | - Davance Mwasomola
- Mbeya Zonal Referral Hospital, Mbeya PO Box 419, Tanzania; (P.K.); (G.M.); (I.M.); (D.M.); (A.N.)
| | - Megan Seddon
- Sarasota Memorial Health Care System, Sarasota, FL 34239, USA;
| | - Mark Shaffer
- School of Medicine, University of South Carolina, Columbia, SC 29209 USA; (M.S.H.); (M.S.)
| | - Stephanie C. Shealy
- College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA; (J.B.); (P.B.B.); (S.C.S.)
| | - Anthony Nsojo
- Mbeya Zonal Referral Hospital, Mbeya PO Box 419, Tanzania; (P.K.); (G.M.); (I.M.); (D.M.); (A.N.)
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