Background
In low- and middle-income countries, the prevalence of antimicrobial resistance (AMR) is increasing. To control AMR, WHO recommends monitoring antibiotic use, in particular Watch antibiotics. These are critically important antibiotics, with restricted use because at risk of becoming ineffective due to increasing AMR. We investigated pre-hospital antibiotic use in rural Burkina Faso.
Methods
During 2016-2017, we collected data from patients aged >3 months presenting with severe acute fever to the rural hospital of Nanoro Health District, Burkina Faso, including antibiotic use in the two weeks prior to consultation or hospitalization. We analysed reported antibiotic use with the WHO Access, Watch, Reserve (AWaRe) classification.
Results
Of 920 febrile participants (63.0% ≤14 years), pre-hospital antibiotic use was reported by 363 (39.5%). Among these 363, microbiological diagnoses were confirmed for 275 (75.8%) patients, of which 162 (58.9%) were non-bacterial infections. Use of more than one antibiotic was reported by 58/363 (16.0%) participants. Of 491 patients who did not previously visit a primary health center, 131 (26.7%) reported antibiotic use. Of 424 antibiotics reported, 263 (62.0%) were Access and 159 (37.5%) Watch antibiotics. Watch antibiotic use was more frequent among patients >14 year olds (51.1%) compared to those 0-14 year old (30.7%) and among referrals from the primary health centers (42.2%) compared to self-referred patients (28.1%). Most frequently reported Watch antibiotics were ceftriaxone (114, 71.7%) and ciprofloxacin (32, 20.1%).
Conclusion
The reported frequent use of Watch group antibiotics among febrile patients prior to presentation to the hospital in rural Burkina Faso highlights the need to develop targeted interventions to improve antibiotic use in community settings as part of strengthening antibiotic stewardship in low- and middle-income countries. This should include facilitating referral, access to qualified prescribers and diagnostic tools in rural primary health centers.
Trial registration
: ClinicalTrials.gov identifier: NCT02669823. Registration date was February 1, 2016