Point Prevalence Survey of Antimicrobial Prescription in a Tertiary Hospital in South East Nigeria: A call for improved antibiotic stewardship

Abstract Background Antimicrobial prescribing practices and use contribute to the growing threat of antimicrobial resistance (AMR) to the global health. Information on antimicrobial prescribing and use is lacking in most developing countries including Nigeria. This information is crucial for antimicrobial stewardship programmes (ASP), an effective tool in minimizing AMR. We carried out this study to gather baseline information on antimicrobial prescribing practices. Methods A cross-sectional survey was conducted on all inpatients of a tertiary hospital in South-Eastern Nigeria. All patients on admission on the same day formed the denominator of the study. We adopted a standardized questionnaire, web-based data entry and validation process designed by the University of Antwerp, Belgium. We collected information on basic patient demographics, antimicrobial agents used, indication for treatment, laboratory data prior to treatment, stop/review date. Results Of the 220 inpatients surveyed, 78.2% were on at least one antimicrobial agent. The highest prevalence of antimicrobial use was in the ICU (100%), adult surgical ward (82.9%) and paediatric medical ward (82.9%). Agents used were mainly third-generation cephalosporin (37.5%) and nitroimidazole (33.9%). Antimicrobial prescription was empirical (91.1% in medical wards, 96.8% in surgical wards and 100% in intensive care unit). There was limited use of guidelines; clear documentation of stop/review dates and reasons for the antimicrobial use. Conclusion Although, a majority of antimicrobial prescriptions were made with indications, they were mostly prescribed on an empirical basis and majority of the prescriptions were parenteral formulations. There is a need to develop an antibiotic guideline, educate the prescribers on antimicrobial stewardship and encourage targeted prescription.