Point Prevalence Survey of Antimicrobial Prescribing in a Nigerian Hospital: Findings and Implications on Antimicrobial Resistance

BACKGROUND

Antimicrobial resistance is a global health challenge. There is inadequate information on antimicrobial prescribing practices in many sub-Saharan African countries including Nigeria. A standardized method for surveillance of antimicrobial use in hospitals was employed to assess the antimicrobial prescribing practices in UCH, Ibadan, Nigeria.

METHODS

A point prevalence survey (PPS) was conducted in December 15, 2017 at the UCH Ibadan. The survey included all in-patients receiving an antimicrobial on the day of PPS. Data collected included details on the antimicrobial agents, reasons and indications for treatment as well as a set of quality indicators. A web-based application was used for data-entry, validation and reporting as designed by the University of Antwerp (www.global-pps.be).

RESULTS

This survey included 451 patients from 38 different wards of which 59.6% received at least one antimicrobial. The neonatal medical wards contributed the highest number of patients who received antibiotics. A total of 172 therapeutic antibiotic prescriptions were issued, mainly for Community Acquired Infections (n=119; 69.2%). Most prescriptions for Healthcare Associated Infections (n=53) were intervention related (47.2%). Frequently used antibiotics include third generation cephalosporins (23.9%; mainly ceftriaxone); followed by combination of penicillin's (17.4%; mainly amoxicillin with enzyme inhibitor) and fluoroquinolones (16.6%). Majority, 312(69.9%)of the patients had parenteral antibiotics and only 95 (21.3%) of all antibiotic prescriptions had a documented stop or review date. Although the reason for antibiotic prescription was indicated for 413 (92.4%) prescriptions, targeted therapy was the basis for only 17 (3.8%)of these prescriptions. For surgical prophylaxis, 98.7% of all prescriptions were given for more than one day. Compliance to guidelines was non-existent.

CONCLUSION

Our findings showed high broad spectrum prescribing, high number of intervention related health care infections, high use of prolonged surgical prophylaxis, inexistence of local guidelines; and low utilization of laboratory facilities. Hospital related intervention should include development of antibiotic guideline and increased enlightenment on rational prescribing practices.

Studies on antifertility effect of pawpaw seeds (Carica papaya) on the gonads of male albino rats

Preliminary studies on the antifertility effect of pawpaw seeds (Carica papaya) on the gonads of male albino (Wistar) rats was investigated. An oral dose of crude ripe pawpaw seeds at 100 mg/kg body weight and 50 mg/kg body weight were administered orally for 8 weeks. Histological observations at a high dose of 100 mg/kg body weight showed degeneration of the germinal epithelium and germ cells, a reduction in the number of Leydig cells and the presence of vacuoles in the tubules. At a low dose of 50 mg/kg body weight little effect was observed. However, there was disorganization in some of the seminiferous tubules while others appeared normal. Leydig cells also appeared normal compared with the controls. At a high dose the epididymis showed many empty tubules containing degenerated spermatozoa and cell debris in the lumen. The epithelium appeared normal compared with the controls. At a low dose a milder effect was observed. The epithelial tissue appeared normal. A possible mechanism of action is discussed.