Parenteral Antibiotic Use at a General Surgery Department of a Large Teaching Hospital in Ghana

Background: Inappropriate use of antimicrobial agents has been found to be common in developing countries where antibiotics are prescribed without indications and sometimes without bacteriological basis. This study evaluated the use of parenteral antibiotics at a general surgical department of a large tertiary care health facility in Ghana.

Methods: A prospective cross-sectional study was conducted by obtaining data on parenteral antibiotic use from computerised software records at the Surgical Pharmacy department using a pretested, specially designed data collection form. Information on parenteral antibiotic use such as name of parenteral antibiotic, dose, dosage regimen and duration of therapy were also extracted daily from in-patients' medical records using a designed data collection form. Results for culture and sensitivity testing and indications for parenteral antibiotic use were also documented. Self-administered questionnaires were then administered to 2 consultant surgeons, 6 specialist surgeons and 4 medical officers.

Results: The highest consumed parenteral antibiotic was metronidazole, with the least being amikacin. The mean number of parenteral antibiotics administered per patient was 2.03 (SD±0.64) while the mean duration of administration was 4.23 (SD±1.36) days. Surgical antibiotic prophylaxis was administered to 94.1% of patients operated upon. The commonest parenteral antibiotic administered as monotherapy was co-amoxiclav (amoxicillin +clavulanic acid). A combination of ciprofloxacin and metronidazole was administered to 54.5% of patients and 76% of patients who received surgical prophylaxis. Culture and sensitivity tests were conducted in only 6 (1.6%) of the patients. Two-thirds of the prescribers requested for culture and sensitivity tests in less than 25% of their patients, while over 90% of the surgeons indicated that prescribing decisions were based on previous experience. Almost all the patients (96.4%) had at least one drug-related problem with their prescriptions that required intervention. These problems were wrong drug choice (2.1%), dosing problems (48.2%), drug use problems (49.6%) and adverse reactions (0.1%).

Conclusion: Parenteral antibiotics were frequently used and prescribers rely more on experience than laboratory investigations. There were also drug-related problems identified including wrong drug choice, wrong doses, drug use problems and adverse drug reactions that required clinical interventions to prevent them from reaching patients. This has implications for the development of antibiotic-use policy to promote rational antibiotic use in surgery.