Cape Town Metro clinics ignoring guidelines on antibiotics

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Clinics are ignoring guidelines on prescribing antibiotics more than half of the time‚ a study has found. And almost one in five people who were given the medication at eight Cape Town clinics did not need it. Others were given incorrect doses or the wrong type of antibiotic‚ or were told to take the drugs for the wrong length of time. In a few cases‚ people who needed antibiotics did not get them.

The study‚ led by Julia Gasson of the Western Cape Health Department‚ was conducted in the context of global concerns about antibiotic resistance caused by over-prescription‚ and found that national guidelines were being overlooked. Some clinics performed better than others, but overall‚ proper procedures were followed only 45% of the time. “The inappropriate and irrational use of antibiotics has contributed significantly to the development of antibiotic resistance‚” the researchers report.

Globally‚ 700,000 people die each year from drug-resistant infections‚ and there are fears that without intervention‚ this will increase to 10m by 2050.

“In a post-antibiotic era‚ infections will become untreatable. Antibiotic resistance in an individual patient is evident for one month following an antibiotic course and can last for up to 12 months‚” the researchers said.

The report say the most common error recorded in the 2016 Cape Town study‚ involving 654 patients‚ was that diagnoses were not entered in medical records. The researchers called for targeted antibiotic education for healthcare professionals and patients‚ with a special focus on the worst-performing clinics.

On its website‚ the South African Antibiotic Stewardship Programme says South Africa needs a “strong‚ co-ordinated and urgent response” to over-prescribing. “Clinical governance of antibiotic prescribing through dedicated programmes and infection-control practice must be strengthened if we are to control the situation.”

Abstract
Background: Knowledge of antibiotic prescribing practice in primary care in South Africa is limited. As 80% of human antibiotic use is in primary care, this knowledge is important in view of the global problem of antibiotic resistance.
Objectives: To assess antibiotic prescribing in primary care facilities in the Cape Town Metro District and compare it with current national guidelines, and to assess the reasons why prescriptions were not adherent to guidelines.
Methods: A retrospective medical record review was performed in April/May 2016. Records of all patients seen over 2 days in each of eight representative primary care facilities in the Cape Town Metro District were reviewed. The treatment of any patient who raised a new complaint on either of those days was recorded. Prophylactic antibiotic courses, tuberculosis treatment and patients with a non-infection diagnosis were excluded. Treatment was compared with the Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, 2014 edition.
Results: Of 654 records included, 68.7% indicated that an antibiotic had been prescribed. Overall guideline adherence was 45.1%. Adherence differed significantly between facilities and according to the physiological system being treated, whether the prescription was for an adult or paediatric patient, and the antibiotic prescribed. Healthcare professional type and patient gender had no significant effect on adherence. The main reasons for non-adherence were an undocumented diagnosis (30.5%), antibiotic not required (21.6%), incorrect dose (12.9%), incorrect drug (11.5%), and incorrect duration of therapy (9.5%).
Conclusions: This study demonstrates poor adherence to guidelines. Irrational use of antibiotics is associated with increased antibiotic resistance. There is an urgent need to improve antibiotic prescribing practice in primary care in the Cape Town Metro District.

Authors
J Gasson, M Blockman, B Willems

Business Day report
SA Medical Journal abstract


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