There is paucity of data describing the rate and quality indices of
antibiotics used among hospitalized patients at continental level in Africa. This systematic review evaluated the pooled prevalence, indications, and types of
antibiotics used in hospitals across Africa.
METHODS: Three electronic databases, PubMed, Scopus, and African Journals Online (AJOL), were searched using search terms. Point prevalence studies of
antibiotic use in inpatient settings published in English language from January 2010 to November 2022 were considered for selection. Additional articles were identified by checking the reference list of selected articles.
RESULTS: Of the 7254 articles identified from the databases, 28 eligible articles involving 28 studies were selected. Most of the studies were from Nigeria (n = 9), Ghana (n = 6), and Kenya (n = 4). Overall, the prevalence of
antibiotic use among hospitalized patients ranged from 27.6 to 83.5% with higher prevalence in West Africa (51.4-83.5%) and North Africa (79.1%) compared to East Africa (27.6-73.7%) and South Africa (33.6-49.7%). The ICU (64.4-100%; n = 9 studies) and the pediatric medical ward (10.6-94.6%; n = 13 studies) had the highest prevalence of
antibiotic use.
Community-acquired infections (27.7-61.0%; n = 19 studies) and surgical
antibiotic prophylaxis (SAP) (14.6-45.3%; n = 17 studies) were the most common indications for
antibiotic use. The duration of SAP was more than 1 day in 66.7 to 100% of the cases. The most commonly prescribed
antibiotics included
ceftriaxone (7.4-51.7%; n = 14 studies),
metronidazole (14.6-44.8%; n = 12 studies),
gentamicin (n = 8 studies; range: 6.6-22.3%), and
ampicillin (n = 6 studies; range: 6.0-29.2%). The access, watch, and reserved group of
antibiotics accounted for 46.3-97.9%, 1.8-53.5%, and 0.0-5.0% of
antibiotic prescriptions, respectively. The documentation of the reason for
antibiotic prescription and date for stop/review ranged from 37.3 to 100% and 19.6 to 100%, respectively.
CONCLUSION: The point prevalence of
antibiotic use among hospitalized patients in Africa is relatively high and varied between the regions in the continent. The prevalence was higher in the ICU and pediatric medical ward compared to the other wards.
Antibiotics were most commonly prescribed for
community-acquired infections and for SAP with
ceftriaxone,
metronidazole, and
gentamicin being the most common
antibiotics prescribed. Antibiotic stewardship is recommended to address excessive use of SAP and to reduce high rate of
antibiotic prescribing in the ICU and pediatric ward.