Over-prescription of Watch antibiotics in primary healthcare settings in Sudan: results from routinely collected prescription data

Abstract

Introduction: Antimicrobial resistance represents a significant challenge in Sudan, further exacerbating the burden on healthcare systems already grappling with infectious disease epidemics. This study aims to examine the patterns of antibiotic prescription in primary healthcare settings (PHC) in Sudan and its compliance to the World Health Organization (WHO) Access, Watch and Reserve (AWaRe) antibiotic book.

Methodology: We collected retrospective data on antibiotic prescriptions at 325 PHCs in five states in Sudan for 2022. We collected patient-level data only for prescriptions with at least one antimicrobial prescribed. We used descriptive analysis to identify patterns of antibiotic prescribing according to the WHO AWaRe classification and to calculate the compliance of antibiotic prescriptions against the WHO AWaRe antibiotic book.

Results: A total of 52,274 antimicrobials were prescribed during 41,102 outpatient visits. Antibiotics accounted for 84.1% (n = 43,941) of prescriptions, of which 29.0% (n = 15,160) belonged to the Access antibiotics while 71.0% (n = 37,114) were from the Watch group. None of the prescribed antibiotics were from the Reserve group. Treatment of community-acquired pneumonia showed the highest compliance to the WHO AWaRe antibiotic book (40.1%, n = 447) followed by typhoid (31.5%, n = 53) and urinary tract infection (22.2%, n = 486). Though mostly caused by viral etiology, all patients with bronchitis received antibiotics.

Conclusions: Over-prescribing Watch antibiotics in outpatient settings in Sudan necessitates adopting multifaceted approaches including context-specific antimicrobial stewardship programs and behavioral change interventions targeting patients and prescribers.