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Khursheed N, Ahsan Q, Rattani S, Fatima M, Raza A, Tariq S, Mustafa T, Ahmed K, Iqbal S, Zulfiqar S, Ahmed SM, Fatima G, Akbar Khan S, Ullah F, Ahmed RA, Jamal S. Point prevalence probing of antimicrobial prescription patterns from a developing country. Expert Rev Anti Infect Ther 2023:1-8. [PMID: 37712527 DOI: 10.1080/14787210.2023.2259098] [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: 06/26/2023] [Revised: 08/04/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Irrational use of antibiotics intensifies resistance and jeopardizes advances made in modern medicine. We aimed to conduct a baseline gap analysis survey on antibiotic prescription practices across Pakistan. RESEARCH DESIGN AND METHODS This multi-centered cross-sectional survey was conducted at six public sector tertiary care hospitals from February 2021 to March 2021. Data related to various variables including hospital infrastructure, policies and practices, monitoring and feedback, and epidemiological, clinical, and antibiotic prescription for surveyed patients was collected using World Health Organization (WHO) Point Prevalence Survey (PPS) methodology. RESULTS In a survey of 837 inpatients, 78.5% were prescribed antibiotics. Most commonly prescribed antimicrobial was ceftriaxone (21.7%), followed by metronidazole (17.3%), cefoperazone-sulbactam (8.4%), amoxicillin-clavulanate (6.3%), and piperacillin/tazobactam (5.9%). Surgical prophylaxis (36.7%) and community-acquired infections (24.7%) were the main reasons for antibiotic prescriptions. Single antibiotics were given to 46.7% of patients, 39.9% received a combination of two antibiotics, and 12.5% were prescribed three or more antibiotics. Among six hospitals surveyed, two had drug and therapeutic committees, three had infection prevention and control committees, and one had an antibiotic formulary. CONCLUSION Findings demonstrate high consumption of broad-spectrum antimicrobials and emphasize the importance of expanding antimicrobial stewardship programs among hospitals. Mentoring clinical teams could help rationalize antimicrobial use.
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Affiliation(s)
- Nazia Khursheed
- Indus Hospital and Health Network, Fleming Fund Country Grant, Karachi, Pakistan
| | - Qadeer Ahsan
- DAI - Fleming Fund Country Grant, Islamabad, Pakistan
| | - Salima Rattani
- Indus Hospital and Health Network, Fleming Fund Country Grant, Karachi, Pakistan
| | - Madeeha Fatima
- Indus Hospital and Health Network, Fleming Fund Country Grant, Karachi, Pakistan
| | - Ali Raza
- Indus Hospital and Health Network, Fleming Fund Country Grant, Karachi, Pakistan
| | - Saba Tariq
- DAI - Fleming Fund Country Grant, Islamabad, Pakistan
| | | | - Kamran Ahmed
- Indus Hospital and Health Network, Fleming Fund Country Grant, Karachi, Pakistan
| | - Sadia Iqbal
- Indus Hospital and Health Network, Fleming Fund Country Grant, Karachi, Pakistan
| | | | | | - Ghulam Fatima
- Dr Ruth K. M. Pfau Civil Hospital Karachi, Karachi, Pakistan
| | | | - Farman Ullah
- Provincial Head Quarter Hospital, Gilgit, Pakistan
| | | | - Saba Jamal
- Indus Hospital and Health Network, Fleming Fund Country Grant, Karachi, Pakistan
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Ambreen S, Safdar N, Ikram A, Baig MZI, Farooq A, Amir A, Saeed A, Sabih F, Ahsan Q, Zafar A, Mahipala PG, Saleem Z, Salman M. Point Prevalence Survey of Antimicrobial Use in Selected Tertiary Care Hospitals of Pakistan Using WHO Methodology: Results and Inferences. Medicina (Kaunas) 2023; 59:1102. [PMID: 37374306 PMCID: PMC10303015 DOI: 10.3390/medicina59061102] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/20/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
Background and objectives: The inappropriate use of antibiotics in hospitals can potentially lead to the development and spread of antibiotic resistance, increased mortality, and high economic burden. The objective of the study was to assess current patterns of antibiotic use in leading hospitals of Pakistan. Moreover, the information collected can support in policy-making and hospital interventions aiming to improve antibiotic prescription and use. Methodology and materials: A point prevalence survey was carried out with data abstracted principally from patient medical records from 14 tertiary care hospitals. Data were collected through the standardized online tool KOBO application for smart phones and laptops. For data analysis, SPSS Software was used. The association of risk factors with antimicrobial use was calculated using inferential statistics. Results: Among the surveyed patients, the prevalence of antibiotic use was 75% on average in the selected hospitals. The most common classes of antibiotics prescribed were third-generation cephalosporin (38.5%). Furthermore, 59% of the patients were prescribed one while 32% of the patients were prescribed two antibiotics. Whereas the most common indication for antibiotic use was surgical prophylaxis (33%). There is no antimicrobial guideline or policy for 61.9% of antimicrobials in the respected hospitals. Conclusions: It was observed in the survey that there is an urgent need to review the excessive use of empiric antimicrobials and surgical prophylaxis. Programs should be initiated to address this issue, which includes developing antibiotic guidelines and formularies especially for empiric use as well as implementing antimicrobial stewardship activities.
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Affiliation(s)
- Saadia Ambreen
- National Institute of Health, Park Road, Islamabad 45501, Pakistan (A.I.); (A.A.); (M.S.)
| | - Numrah Safdar
- National Institute of Health, Park Road, Islamabad 45501, Pakistan (A.I.); (A.A.); (M.S.)
| | - Aamer Ikram
- National Institute of Health, Park Road, Islamabad 45501, Pakistan (A.I.); (A.A.); (M.S.)
| | | | - Ayesha Farooq
- National Institute of Health, Park Road, Islamabad 45501, Pakistan (A.I.); (A.A.); (M.S.)
| | - Afreenish Amir
- National Institute of Health, Park Road, Islamabad 45501, Pakistan (A.I.); (A.A.); (M.S.)
| | - Asim Saeed
- National Institute of Health, Park Road, Islamabad 45501, Pakistan (A.I.); (A.A.); (M.S.)
| | - Farah Sabih
- World Health Organization, Country Office, Park Road, Islamabad 45501, Pakistan (P.G.M.)
| | - Qadeer Ahsan
- The Fleming Fund Country Grant, DAI Office, Beverly Centre, F-6/1, Blue Area, Islamabad 04403, Pakistan
| | - Alia Zafar
- World Health Organization, Country Office, Park Road, Islamabad 45501, Pakistan (P.G.M.)
| | | | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakaria University, Multan 60800, Pakistan;
| | - Muhammad Salman
- National Institute of Health, Park Road, Islamabad 45501, Pakistan (A.I.); (A.A.); (M.S.)
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Hayman DTS, Barraclough RK, Muglia LJ, McGovern V, Afolabi MO, N'Jai AU, Ambe JR, Atim C, McClelland A, Paterson B, Ijaz K, Lasley J, Ahsan Q, Garfield R, Chittenden K, Phelan AL, Lopez Rivera A. Addressing the challenges of implementing evidence-based prioritisation in global health. BMJ Glob Health 2023; 8:e012450. [PMID: 37290897 PMCID: PMC10255200 DOI: 10.1136/bmjgh-2023-012450] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/14/2023] [Indexed: 06/10/2023] Open
Abstract
Global health requires evidence-based approaches to improve health and decrease inequalities. In a roundtable discussion between health practitioners, funders, academics and policy-makers, we recognised key areas for improvement to deliver better-informed, sustainable and equitable global health practices. These focus on considering information-sharing mechanisms and developing evidence-based frameworks that take an adaptive function-based approach, grounded in the ability to perform and respond to prioritised needs. Increasing social engagement as well as sector and participant diversity in whole-of-society decision-making, and collaborating with and optimising on hyperlocal and global regional entities, will improve prioritisation of global health capabilities. Since the skills required to navigate drivers of pandemics, and the challenges in prioritising, capacity building and response do not sit squarely in the health sector, it is essential to integrate expertise from a broad range of fields to maximise on available knowledge during decision-making and system development. Here, we review the current assessment tools and provide seven discussion points for how improvements to implementation of evidence-based prioritisation can improve global health.
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Affiliation(s)
- David T S Hayman
- Molecular Epidemiology and Public Health Laboratory, Massey University, Palmerston North, New Zealand
| | - Rosemary K Barraclough
- Molecular Epidemiology and Public Health Laboratory, Massey University, Palmerston North, New Zealand
| | - Louis J Muglia
- Burroughs Wellcome Fund, Research Triangle Park, North Carolina, USA
| | - Victoria McGovern
- Burroughs Wellcome Fund, Research Triangle Park, North Carolina, USA
| | - Muhammed O Afolabi
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Alhaji U N'Jai
- Department of Microbiology, University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
- Department of Biological Sciences, University of Sierra Leone Fourah Bay College, Freetown, Sierra Leone
| | - Jennyfer R Ambe
- The Global Emerging Pathogens Treatment Consortium, Lagos, Nigeria
| | - Chris Atim
- Results for Development (R4D), Accra, Ghana
| | | | - Beverley Paterson
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kashef Ijaz
- Health Programs, The Carter Center, Atlanta, Georgia, USA
| | | | - Qadeer Ahsan
- Australia Indonesia Health Security Partnership, Jakarta, Indonesia
| | | | | | - Alexandra L Phelan
- Center for Health Security, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Abigail Lopez Rivera
- US Department of Health and Human Services, Washington, District of Columbia, USA
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Masood NA, Ahsan Q. A Methodology for Identification of Weather Sensitive Component of Electrical Load Using Empirical Mode Decomposition Technique. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/epe.2013.54029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
An inflammatory polyarthritis has been previously described in leprosy but accounts of the clinical characteristics have varied. All patients with joint symptoms admitted to a leprosy centre over 5 months were examined by a rheumatologist. Of 48 acute admissions, 20 (42%) had a symmetrical polyarthritis affecting the wrists and fingers. This was strikingly similar to RA in appearance. The arthritis occurred exclusively in patients with reactions mainly during anti-mycobacterial treatment. The clinical features of the joint disorder were identical in Type I (associated with alterations in immune status) and Type II (erythema nodosum leprosum) reactions. Synovial tissue from one patient revealed no mycobacteria. Four of five hand X-rays suggested small erosions of the finger joints.
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Affiliation(s)
- T Gibson
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Schenk K, Ahsan Q, Vassos S. The Segmentation Method Applied to the Evaluation of Loss of Load Probability of Two Interconnected Systems. ACTA ACUST UNITED AC 1984. [DOI: 10.1109/tpas.1984.318622] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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