Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Implementation of a Delayed Prescribing Model to Reduce Antibiotic Prescribing for Suspected Upper Respiratory Tract Infections in a Hospital Outpatient Department, Ghana

Sam Ghebrehewet
* ,
Wendi Shepherd
ORCID logo ,
Edwin Panford-Quainoo
ORCID logo ,
Saran Shantikumar
,
Valerie Decraene
,
Rajesh Rajendran
,
Menaal Kushal
,
Afua Akuffo
,
Dinah Ayerh
,
George Amofah
Version 1 : Received: 31 August 2020 / Approved: 1 September 2020 / Online: 1 September 2020 (11:29:47 CEST)

A peer-reviewed article of this Preprint also exists.

Ghebrehewet, S.; Shepherd, W.; Panford-Quainoo, E.; Shantikumar, S.; Decraene, V.; Rajendran, R.; Kaushal, M.; Akuffo, A.; Ayerh, D.; Amofah, G. Implementation of a Delayed Prescribing Model to Reduce Antibiotic Prescribing for Suspected Upper Respiratory Tract Infections in a Hospital Outpatient Department, Ghana. Antibiotics 2020, 9, 773. Ghebrehewet, S.; Shepherd, W.; Panford-Quainoo, E.; Shantikumar, S.; Decraene, V.; Rajendran, R.; Kaushal, M.; Akuffo, A.; Ayerh, D.; Amofah, G. Implementation of a Delayed Prescribing Model to Reduce Antibiotic Prescribing for Suspected Upper Respiratory Tract Infections in a Hospital Outpatient Department, Ghana. Antibiotics 2020, 9, 773.

Abstract

This service improvement project was carried out at LEKMA Hospital, Ghana. Ghana has high levels of antimicrobial resistance (AMR). There is an urgent need to introduce models of care that optimize antibiotic prescribing. Methods Delayed / back-up prescribing is a strategy that could reduce antibiotic use in suspected upper respiratory tract infections. Four different models of delayed / back-up prescribing [no prescription; post-dated prescription (given to patient); post-dated prescription (forwarded to pharmacy); and follow-up appointment for reassessment after 3 days] were implemented in discussion between clinician and patient. Patients were contacted 10 days after their appointment to record compliance, check on their wellbeing, and rate their experience. Results Over a 3-month period (12/2019-02/2020), 142 patients were eligible for delayed / back-up prescribing. The most common clinical diagnoses were sore throat (102/140, 73%), common cold (22/140, 16%) and sinusitis (10/140, 7%). In total, 12 (9%) patients remained symptomatic at day 10, and only one individual in the entire cohort took antibiotics. Most patients (95%) rated their experience as good or very good. Conclusions Delayed / back-up prescribing models can lead to substantial reduction in antibiotic consumption amongst outpatient department patients with suspected upper respiratory tract infections. Delayed / back-up prescribing can be implemented safely in low and middle-income countries.

Keywords

Antimicrobial Resistance (AMR); Antimicrobial Stewardship (AMS); delayed/back-up prescribing; upper respiratory tract infections; developing countries; LMICs; Ghana

Subject

Medicine and Pharmacology, Pulmonary and Respiratory Medicine

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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