Point Prevalence Survey of Antibiotic Use in Level 1 hospitals in Zambia: Future Prospects for Antimicrobial Stewardship Programs

Steward Mudenda,1– 3 Adriano Focus Lubanga,4,5 Shazia Jamshed,6 Bibian Biemba,1 Racheal Sakala,1 Mervis Chiyabi,1 Lorraine Kavubya,1 Linda Twaambo Milambo,1 Flavien Nsoni Bumbangi,7 Joseph Yamweka Chizimu,3 Kaunda Yamba,8 Evelyn Wesangula,9 Audrey Chigome,10 Aubrey Chichonyi Kalungia,1 Israel Abebrese Sefah,11 Zia UI Mustafa,12,13 Amos Yared Massele,14 Zikria Saleem,15 Richard Mutemwa,16 Eustarckio Kazonga,16 Massimo Sartelli,17 Johanna Catharina Meyer,10,18 John Bwalya Muma,19 Roma Chilengi,3 Brian Godman10,20 1Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia; 2Education and Continuous Professional Development Committee, Pharmaceutical Society of Zambia, Lusaka, Zambia; 3Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka, Zambia; 4Education and Research, Clinical Research Education and Management Services (CREAMS), Lilongwe, Malawi; 5Department of Clinical Services, Kamuzu Central Hospital (KCH), Lilongwe, Malawi; 6Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia; 7Department of Medicine and Clinical Sciences, School of Medicine, Eden University, Lusaka, Zambia; 8Action on Antibiotic Resistance (React) Africa, Lusaka, Zambia; 9Strengthening Pandemic Preparedness, Eastern, Central, and Southern Africa Health Community, Arusha, Tanzania; 10Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa; 11Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ghana; 12Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, Malaysia; 13Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan, 57400, Pakistan; 14Department of Clinical Pharmacology and Therapeutics, Kairuki University, Dar Es Salaam, Tanzania; 15Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan; 16Department of Public Health, School of Medicine and Health Sciences, University of Lusaka, Lusaka, Zambia; 17Department of Surgery, Macerata Hospital, Macerata, Italy; 18South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa; 19Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia; 20Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UKCorrespondence: Adriano Focus Lubanga, Clinical Research Education and Management Services (CREAMS), Anderson House, Area 43, P. O Box 31045, Lilongwe, Malawi, Tel +265992744497, Email [email protected]: The inappropriate prescribing and use of antibiotics have contributed to the emergence and spread of antimicrobial resistance (AMR). In Zambia, there is a paucity of information on the prescribing patterns and use of antibiotics among hospitalized patients in level 1 hospitals. This study investigated antibiotic use in five level 1 hospitals in Lusaka, Zambia.Methods: This cross-sectional study utilized the World Health Organization (WHO) Point Prevalence Survey (PPS) methodology among in-patients admitted in level 1 hospitals before 08:00 a.m. on the survey day in August 2024. Data were analysed using IBM SPSS version 23.0.Results: The prevalence of antibiotic use among inpatients was 59.0%, with ceftriaxone being the most prescribed. Antibiotics were prescribed mainly for paediatrics and male inpatients. This study found that 53.0% of prescribed antibiotics were from the Access group while 38.2% were from the Watch group of the World Health Organization Access, Watch, and Reserve (AWaRe) classification. Adherence to national treatment guidelines was 36.0%, with most antibiotics prescribed empirically without evidence of culture and sensitivity tests.Conclusion: This study found a high use of antibiotics and low adherence to treatment guidelines in level 1 hospitals in Lusaka, Zambia. The findings of this study demonstrate the need to establish and strengthen antimicrobial stewardship programs and strengthen laboratory capacity to aid clinicians in diagnosing, treating, and managing patients across level 1 hospitals in Zambia.Keywords: antibiotic use, antimicrobial resistance, antimicrobial stewardship, Point Prevalence Survey, Zambia