An Exploration of Antibiotic Stewardship in a Low-Income Setting: Antibiotic use in Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi.
PHE ePoster Library. Wood A. Sep 12, 2019; 274292; 105
Alasdair Wood
Alasdair Wood
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Abstract
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Abstract Background-In many low-income settings, hospital antibiotic stewardship programs are being adopted to combat bacterial resistance. These have rarely been evaluated. In 2016, a stewardship program was introduced at QECH in Blantyre, Malawi. A sustained reduction in antibiotic use has been seen since then. Qualitative exploration was used to contextualise this significant finding.Aim-To explore factors relating to the use of antibiotics at QECH, and to consider how these affect stewardship efforts in this setting.
Methods
-Eleven semi-structured interviews of prescribers at QECH were conducted, regarding their use of antibiotics. This was triangulated with ethnographic observations of ward rounds and medical meetings. Results were analysed using thematic analysis.
Results
-Despite the reported reduction of intravenous-antibiotics use since the intervention, there was an ongoing reliance on these drugs in the minds of prescribers. Prescribers had good theoretical knowledge of stewardship, but the significant pressures exerted on them by their work-environment superseded this and drove them to widespread use of ceftriaxone. These pressures included: epidemiological burden in the community, lack variety of available antibiotics, nursing shortages, insufficient diagnostic facilities, an ingrained culture of prescribing, hierarchical influences, and large responsibilities for junior doctors.
Conclusion
-This is some of the first data relating to stewardship in low-income settings. It revealed many factors about the environment in which prescribers work that shape their prescription practices. It also highlighted structural barriers which significantly constrain continuing stewardship efforts. Interventions aimed at modifying prescribing behaviours may be of limited further use in this setting if the structural barriers are not first addressed. External funding details
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