Antimicrobial Prescribing Practices, Antimicrobial Resistance (AMR)
Conditions
Brief summary
Antimicrobial resistance (AMR) is a critical issue, especially in Africa, with resistance to common antibiotics reaching 100% in some areas. In Tanzania, limited access to culture tests and antibiograms forces healthcare providers to rely on experience for prescribing, heightening AMR risks. This study aims to determine the effectiveness of mobile antibiograms in optimizing empirical antibiotic therapy in tertiary hospitals in Tanzania.
Detailed description
A pragmatic quasi-experimental design (hybrid type 1 trial) will be used to evaluate the effectiveness of mobile antibiograms on antibiotic use. The key role of the antibiogram is to guide empirical treatment of symptomatic infections using antibiotics ie., the antibiogram contains a list of susceptible and resistant antibiotics enabling the prescriber to rationally choose the antibiotic which is effective in clearing the infection. The study employs a three-phase, stepwise approach to assess and enhance antimicrobial use in Tanzanian hospitals. The first phase will be a baseline assessment using World Health Organization's Point Prevalence Survey and defined daily dose (DDD) to determine the pattern of antibiotic utilization and consumption respectively. The second phase involves developing a mobile antibiogram application through a participatory design with healthcare stakeholders. The final phase will use a quasi-experimental design to test the effectiveness of the mobile antibiogram on antimicrobial stewardship metrics like DDD per 1000 patient days, antibiotic appropriateness, infection-related mortality and length of hospital stay. The study sites will be Mbeya Zonal Referral Hospital (MZRH) as the intervention group and Benjamini Mkapa Hospital (BMH) as the control group. Additionally, a mixed-methods design (explanatory sequential design) will be used to assess the acceptability, feasibility, and adoption of the mobile antibiograms.
Interventions
OTHERMobile antibiogram application
A mobile antibiogram application software containing antibiotic sensitivity test results specific to the health facility. This mobile antibiogram application will guide decision support for empirical prescription.
OTHERstandard of care
Participants will be assigned to manual antibiogram only.
Sponsors
Muhimbili University of Health and Allied Sciences
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
1. All prescribers working in the selected tertiary referral hospitals 2. All prescribers owning smartphones 3. Prescribers who consent to take part in the study
Exclusion criteria
1\. Temporarily employed prescribers
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pattern of antibiotic use | 12 months | Proportional change in antibiotic use among admitted patients |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pattern of antibiotic resistance | 12 months | Number of resistances to antibiotics among admitted patients |
| Acceptability of mobile antibiograms | 12 months | % of acceptability of mobile antibiograms among prescribers |
| Feasibility of mobile antibiograms | 12 months | % of feasibility mobile antibiogram among prescribers in tertiary referral hospitals in Tanzania |
| Adoption of mobile antibiogram | 12 months | % of adoption of mobile antibiogram among prescribers in tertiary referral hospitals in Tanzania |
Countries
Tanzania
Contacts
CONTACTAlphonce Ignace Marealle, PhD
CONTACTWigilya Padili Mikomangwa, MSc
Outcome results
None listed