The “readily available” second-line antibiotics are more cost-effective than the “easily accessible” first-line antibiotics as the initial management of Urinary Tract Infections and Chorioamnionitis in Malawi

Background Antimicrobial resistance (AMR) has health and economic implications for patients, healthcare providers, and the society. In Malawi, infections, including AMR, account for 22% of the maternal mortality. Economic evaluation of AMR is required to understand the cost-benefits of bacterial infection treatment strategies and antibiotic prescriptions for maternal infections and AMR. Notably, evidence of the comparative cost-effectiveness of commonly used antibiotics for maternal infection treatment is scarce. Methods Using a decision tree model, we assessed the cost-effectiveness of second-line antibiotics (ciprofloxacin and ceftriaxone) against first-line antibiotics (amoxicillin, gentamicin, and ampicillin) for the management of maternal infections in Malawi. The analysis considered both outpatient (urinary tract infection) and inpatient (chorioamnionitis) scenarios. Results The results indicate that the “readily available” second-line antibiotics have a cost advantage, with incremental-cost-effectiveness-ratios (ICERs) below Malawi’s GDP per capita (634.8 USD/capita). A total of 0.157cents per infection were resolved for urinary tract infection and 0.673 cents per infection were resolved for chorioamnionitis. Conclusion This study provides short-term, static insights into the cost-effectiveness of antibiotic treatment strategies for maternal bacterial infections like UTI and chorioamnionitis in Malawi and similar low-resource settings. Healthcare providers should weigh cost advantage against clinical consequence when: 1) prescribing readily available, easily accessible Access-group antibiotics as first-line treatment, and 2) transitioning patients with confirmed non-response to less accessible, second-line Watch-group agents. Because wider second-line use drives resistance, switching should be guided by susceptibility testing, not adopted by default.