Ceftriaxone Prescription at Muhimbili National Hospital

S Background: Since their discovery, antibiotics have contributed to a dramatic fall in morbidity and mortality from bacterial infections. However, the emergence and spread of antibiotic resistance continues to threaten the effectiveness of these agents. Ceftriaxone is one of the most important medications needed in a basic health system. Yet high levels of inappropriate use have been reported increasing the likelihood of emergence and spread of resistance. Methods: We conducted a descriptive study to characterize ceftriaxone prescription and resistance at a tertiary hospital. Results: Three hundred and sixty prescriptions were observed and 194 (54 %) deviated from the National Treatment guidelines with regards to indication. For patients with conditions for which ceftriaxone is recommended, 93 % (154 out of 166) prescriptions deviated from the guideline with regard to dosing frequency and 67 % deviated with regards to the duration of administration. Coagulase Negative Staphylococcus (CoNS), Escherichia coli, Klebsiella spp, and Pseudomonas aeruginosa were the most common isolates and with the highest ceftriaxone resistance rate (up to 80%). Conclusions: At MNH, ceftriaxone is commonly inappropriately prescribed and the risk of emergence and spread of ceftriaxone resistant isolates may be high.  The majority of CoNS and Klebsiella species are resistant, thus cautious ceftriaxone prescription is needed.