Abstract
Objective
A major problem with inappropriate use of antibiotics is the emergence of resistance. Thus, cost-effective interventional strategies are required to improve their use. This study aimed to evaluate the effect of multifaceted interventions on prescribing practices of antibiotics in health centers of Khartoum State, Sudan.
Methods
Twenty health centers were randomly assigned to receive: (1) no intervention; (2) audit and feedback; (3) audit and feedback + seminar; or (4) audit and feedback + academic detailing. A total of 1,800 patient encounters, 30 from each health center, were randomly collected. The total number of encounters with antibiotics prescribed were determined in each health center and they were evaluated with regard to antibiotic choice, dose and duration of therapy before the study and at 1 and 3 months post-intervention.
Results
In comparison to the control group, the prescriber targeted interventions involving audit and feedback, together with academic detailing (4), reduced the mean number of encounters with an antibiotic prescribed by 6.3 and 7.7 (p<0.001) at 1 and 3 months post-intervention, respectively. In addition, the mean number of encounters with an inappropriate antibiotic with respect to diagnosis, doses and/ or duration of therapy was reduced by 5.3 and 5.9 (p<0.001) at 1 and 3 months post-intervention, respectively. For audit and feedback together with seminars (3) and for audit and feedback alone (2), the corresponding reductions were 5.3, 7.1, 4.4 and 5.1 (p<0.001) and 1.4, 2.8, 1.8 and 1.9 (p>0.05), respectively.
Conclusion
Inappropriate prescribing patterns of antibiotics in health centers of Khartoum State, Sudan, are alarmingly high. Multifaceted interventions involving audit and feedback combined with either academic detailing or seminars appear more effective in changing prescribing practices of antibiotics than audit and feedback alone.
Similar content being viewed by others
References
World Health Organization (1996) The World Health Report. Geneva: WHO
Trostle J (1996) Inappropriate distribution of medicines by professionals in developing countries. Socl Sci Med 42:1117–1120
Hogerzeil HV, Bimo, Ross-Degnan D, Laing RO, Ofori-Adjei D, Santoso B, et al (1993). Field tests for rational drug use in twelve developing countries. Lancet 342:1408–1410
World Health Organization (2002) WHO Fact Sheet on Antimicrobial resistance. Fact Sheet No. 194
Quick JD, Hogerzeil HV, Velasquez G, Rago L (2002) Twenty-five years of Essentials medicines. Bull World Health Organ 80(11):913–914
Kunin CM (1993). Resistance to antimicrobial drugs worldwide calamity. Ann Intern Med 118:557–561
Rahal K, Wang F, Schindler J, Rowe B, Cookson B, Huovinen P, et al (1997) Reports on surveillance of antimicrobial resistance in individual countries. Clin Infect Dis 24(suppl 1):S169–S175
Hoge CW, Gambel JM, Srijan A, Pitarangsi C, Echeverria P (1998) Trends in antibiotic resistance among diarrheal pathogens isolated in Thailnd over 15 years. Clin Infect Dis 26:341–345
Iruka N, Adebayo L, Robert E (1999) Socieconomic and behavioural factors leading to acquired bacterial resistance to antibiotics in developing countries. Emerg Infect Dis 5(1):18–27
Cash R (1996) Inappropriate treatment of dysentery. BMJ 313:181–182
Turnridge J (1995) Epidemiology of of quinolone resistance, eastern hemisphere. Drugs 49:43–47
World Health Organization (1992) The use of essential drugs:model list of essential drugs: fifth report of the WHO Expert Committee, WHO Tech Rep Ser 825:1–75
Munishi GK (1991) The development of essential Drugs Program and implications for self-reliance in Tanzania. J clin Epidemiol 44(Suppl 2):7S–14S
Abdelmoneim IA, El-Tayeb IB, Omer ZB (1999) Investigation of drug use in health centers in Khartoum State. Sudan Med J 37:21–26
Bexell A, Lwando E, von Hofsten B, Tembo S, Eriksson B, Diwan VK (1996) Improving drug use through continuing education: a randomized controlled trial in zambia. J Clin Epidemiol 49:355–357
LA Bero, R Grilli, JM Grimshaw, E Harvey, AD Oxman, MA Thomson (1998) Closing the gap between research and practice: an overview of systemic reviews of interventions to promote the implementation of research findings. BMJ 317:465–468
Angunawela I, Diwan V, Tomson G (1991) Experimental evaluation of the effects of drug information on antibiotic prescribing: a study in outpatient care in an area of Sri Lanka. Int J Epidemiol 20:558–564
Santoso B (1996) Small group intervention vs formal seminar for improving appropriate drug use. Soc Sci Med 42:1163–1168
Newton-Syms FA, Dawson PH, Cooke J, Feely M, Booth TG, Jerwood D, et al (1992) The influence of an academic representative on prescribing by general practitioners. Br J Clin Pharm 33:69–73
Soumerai SB and Avorn J (1990) Principles of educational outreach (Academic detailing) to improve clinical decision making. J Amer Med Ass 263(A):549–556
Eltayeb IB, Awad AI, Mohamed-Salih M.S., Daffa-Alla, MA, Ahmed MB, Ogail MA, Matowe L (2005) Changing the prescribing patterns of sexually transmitted infections in the White Nile Region of Sudan. Sex Transm Infect 81(5):426–427
Mills A, Brugha R, Hanson K, McPake B (2002) What can be done about the private health sector in low-income countries? Bull World Health Organ 80:325–330
Chalker J, Ratanawijitrasin S, Chuc NTK, Petzold M, Tomson G (2005) Effectiveness of a multi-component intervention on dispensing practices at private pharmacies in Vietnam and Thailand: a randomized trial. Soc Sci Med 60:131–141
Shears P, Hart CA, Broadhed RL, Coulter JB (1987) A note on antibiotic resistance in Escherichia coli isolated from children with diarrhoea in the Sudan. Ann Trop Paediatr 7(1):38–41
Sid-Ahmed H (1995) A study report of antimicrobial resistance in isolates from patients with diarrhoea and urinary tract infection in Sudan. A publication of Sudan Essential Drugs Programme
Ibrahim MA (2003) The activity of some antibiotics against clinical isolates taken from diabetic patients with urinary tract infection. Master of Science Thesis, University of Khartoum, Sudan
Awad AI, Eltayeb IB, Matowe L and Thalib L (2005) Self medication with Antibiotics and Antimalarials in the community of Khartoum State, Sudan. J Pharm Pharm Sci 8(2):326–331
Awad AI, Ahmed A and Matowe L (2005) Self-medication with antibiotics and antimalarials among university students in Sudan. Basic and clinical pharmacology & Toxicology-Abstract Book 97 (1);77 – Proceedings of the 7th Congress of the European Association for Clinical Pharmacology and Therapeutics, June 2005, Poland
Awad AI, Eltayeb IB (2001) Antibiotics use: patients in health care centres in Khartoum State. Sudan Med J 39:29–32
Himad HA (2004) A descriptive study of prescribing and dispensing practices in university teaching hospitals in Sudan. Unpublished Master in Clinical Pharmacy Thesis, Robert Gordon University, Aberdeen
World Health Organization. How to investigate drug use in health facilities: selected drug use indicators. Geneva: WHO; 1993; WHO/DAP/93.1.3
Craig Ramsay (2004) EPOC Statistical Editor. Methodology Tips. Unit of analysis errors – cluster randomised trials. The Cochrane Effective Practice and Organization of Care Group, 16:2. http://www.epoc.uottawa.ca/sep2004.pdf
De Vries TPGM, Henning RH, Hogerzeil HV et al (1995) Impact of a short course in pharmacotherapy for undergraduate medical students. Lancet 346:1454–1457
World Health Organization (1994) Ninth Programme Report 1992–1994. Geneva: Programme for Control of Diarrhoeal Diseases, World Health Organization
Sheinfeld Gorin S, Gemson D, Ashford A, Bloch S, Lantigua R, Ahsan H, Neugut A (2000) Cancer education among primary care physicians in an underserved community. Am J Prev med 19(1):53–58
Acknowledgements
This study received financial support from the Sudan Essential Drug Programme. The invaluable assistance of local health authorities through giving their approval and permission for this study is highly acknowledged. We are also grateful to the prescribers who agreed to participate in the study.
Author information
Authors and Affiliations
Corresponding author
Additional information
The study was conducted in Khartoum state, Sudan. Data interpretation and writing were undertaken in Faculty of Pharmacy, Kuwait University and University of Khartoum
Rights and permissions
About this article
Cite this article
Awad, A.I., Eltayeb, I.B. & Baraka, O.Z. Changing antibiotics prescribing practices in health centers of Khartoum State, Sudan. Eur J Clin Pharmacol 62, 135–142 (2006). https://doi.org/10.1007/s00228-005-0089-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00228-005-0089-4