# Improvements in Prescribing Indicators and Antibiotic Utilization Patterns Following Antimicrobial Stewardship Intervention at a District Hospital in Ghana

## TL;DR

An antimicrobial stewardship program at a Ghanaian hospital improved antibiotic prescribing practices and reduced unnecessary use between 2021 and 2023.

## Contribution

The study demonstrates the effectiveness of AMS interventions in improving WHO prescribing indicators in a district hospital setting.

## Key findings

- Antibiotic prescriptions per encounter decreased from 36% to 18% after the intervention.
- Use of generic names increased from 76% to 80%, while injection use dropped from 7% to 6%.
- Prescriptions from the Ghana essential medicines list decreased from 90% to 79%.

## Abstract

Rational use of medicines, particularly antimicrobials, is critical for reducing antimicrobial resistance. In 2021, a study conducted at the outpatient department (OPD) of a district hospital in Ghana, identified high antibiotic prescribing and suboptimal adherence to World Health Organization (WHO) prescribing indicators. Based on those findings, antimicrobial stewardship (AMS) intervention was extended to the OPD. This before-and-after study was used to compare WHO prescribing indicators and patterns of antibiotic use, using WHO AWaRe (Access, Watch and Reserve) categorization of the years 2021 and 2023. A total of 65,157 patients visited the OPD in 2023 with 171,517 patient encounters and 247,313 prescriptions. Encounters resulting in antibiotic prescriptions halved from 36% to 18%. The average number of medicines prescribed per encounter reduced from three to two. Prescriptions using generic names increased from 76% to 80% and injection use reduced from 7% to 6%. However, prescriptions from the Ghana essential medicines list reduced from 90% to 79%. Access antibiotics use remained unchanged while Watch and Reserve categories increased by 5% and 2%, respectively. The AMS interventions potentially improved three of five WHO indicators. Continued efforts are needed to achieve complete compliance with all indicators and increase access antibiotic use to above 70%.