Are Antibiotics Prescribed to Inpatients According to Recommended Standard Guidelines in Juba Teaching Hospital, South Sudan? A Retrospective Cross-sectional Study

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Abstract Background: The emergence and spread of antibiotic resistance occurred at an alarming rate globally, and has limited the use of antibiotics for preventing and treating infectious diseases. Failure to follow guidelines and protocols for antibiotic use for rational therapeutics and infection control has led to overuse and misuse of antibiotics. However, there is paucity of data on the current pattern of antibiotics prescribing for hospitalised patients in South Sudan, which is among the youngest countries in the world. Therefore, this study aimed to explore the prescription and use of antibiotics at Juba Teaching Hospital (JTH) in South Sudan.Methods:A retrospective cross-sectional study was conducted among JTH inpatients between January and December 2016. A sample of 316 files from the medical and surgical wards were extracted using probability sampling proportional to ward size. Extracted files were reviewed to determine the pattern of antibiotics administration. Data on indications for antibiotic use were also collected. All data were entered twice and analysed using STATA version 13.0.Results: In all reviewed files, patients received treatment with antibiotics. Antibiotic use was highest in the medical ward (75.4%). Conditions in which antibiotic use was most prevalent were infectious and parasitic diseases (23.7%) and diseases of the digestive system (19.9%). The top three antibiotics prescribed were ceftriaxone (21.2%), metronidazole (20.0%) and amoxicillin (11.5%). The majority of patients (40.2%) were treated with two antibiotics. Conclusions: This study revealed a high level of inappropriate antibiotics use at JJTH. Furthermore, there is non-adherence to national/international guidelines in administration of these antibiotics among doctors. It is necessary to introduce antibiotic stewardship activity, along with continuous national surveillance and enforcement to reduce irrational antibiotics use and the associated risk for antibiotic resistance.

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