An assessment of antimicrobial prescribing at a tertiary hospital in north-western Nigeria

Background: Inappropriate antibiotic use is a public health problem worldwide. Misuse of these agents is one of the drivers of antimicrobial resistance (AMR), which is believed to be the next pandemic. Consequently, auditing antimicrobial prescription patterns can provide useful information on the scope and extent of this problem. Objective: The aim of this study was to describe outpatient antimicrobial drug prescribing at the National Health Insurance Scheme (NHIS) unit of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Methodology: This was a descriptive drug utilization study carried out prospectively during a 2 week period in May 2015. Six objective World Health Organization (WHO) indicators were used to assess the rationality of antimicrobial prescribing at the site. Data collected on antimicrobials included type, route of administration, dose and dosing frequency as well as length of therapy. Average costs (both prescription and antibiotic) were obtained by dividing the total drug costs by the relevant number of drugs. Results: A total of 167 prescriptions were analyzed. The average number of drugs per encounter in the facility was 3.7. Fifty seven percent of antimicrobials were prescribed using their generic names, while the average duration of treatment was 8.9 days. Thirty seven prescriptions (22%) contained more than one prescribed antimicrobial, out of which 7 were potentially pharmacologically antagonistic. Only 21% of the prescriptions had indications in line with the National Standard Treatment Guidelines (STG’s). Average cost of prescribed antimicrobials was about NGN 2,238 (approximately US$11). Conclusion: Several problems associated with rational antimicrobial prescribing were identified. There is a definite need for suitable interventions to help improve antimicrobial drug prescribing at the site. Keywords: Anti-infective agents, Costs, Drug use review, National Health Insurance, Nigeria