Table 2.
Antimicrobial use, indications, and tools to guide therapy across study sites in Tanzania, Kenya, and Sri Lanka (N = 1,573).
| Antimicrobial therapy | Country | ||||
|---|---|---|---|---|---|
| Tanzania (n = 390) | Kenya (n = 424) | Sri Lanka (n = 759) | Overall (n = 1,573) | ||
| Antimicrobial | Narrow-spectrum penicillina | 55 (14.1) | 13 (3.1) | 80 (10.5) | 148 (9.4) |
| Vancomycin | 2 (0.5) | 19 (4.5) | 5 (0.6) | 26 (1.6) | |
| 1st and 2nd generation cephalosporin | 0 | 8 (1.9) | 13 (1.7) | 21 (1.3) | |
| 3rd generation cephalosporin | 286 (73.3) | 309 (72.9) | 226 (29.8) | 821 (52.2) | |
| 4th generation cephalosporin | 0 | 31 (7.3) | 2 (0.3) | 33 (2.1) | |
| Amoxicillin and clavulanic acid | 24 (6.2) | 32 (7.5) | 378 (49.8) | 434 (27.6) | |
| Metronidazole | 158 (40.5) | 86 (20.3) | 43 (5.7) | 287 (18.2) | |
| Macrolidesb | 18 (4.6) | 102 (24.0) | 173 (22.8) | 293 (18.6) | |
| Tetracycline/doxycycline | 1 (0.2) | 1 (0.2) | 59 (7.8) | 61 (3.9) | |
| Fluoroquinolone | 13 (3.3) | 35 (8.2) | 100 (13.2) | 148 (9.4) | |
| Aminoglycoside | 7 (1.8) | 2 (0.5) | 7 (0.9) | 16 (1.0) | |
| Carbapenem | 2 (0.5) | 21 (5.0) | 40 (5.3) | 63 (4.0) | |
| Anti-tuberculosis therapy | 12 (3.1) | 46 (10.8) | 0 | 58 (3.7) | |
| Antifungal azole | 8 (2.0) | 41 (9.7) | 0 | 49 (3.1) | |
| Amphotericin | 0 | 6 (1.4) | 0 | 6 (0.4) | |
| Oseltamivir | 0 | 0 | 0 | 0 | |
| Acyclovir | 0 | 5 (1.2) | 5 (0.6) | 10 (0.6) | |
| Antimalarialc | 0 | 7 (1.6) | 0 | 7 (0.4) | |
| Other intravenous/oral medicationd | 45 (11.5) | 65 (15.3) | 91 (12.0) | 201 (12.8) | |
| Anti-retrovirals | 5 (1.3) | 22 (5.2) | 0 | 27 (1.7) | |
| Number of antimicrobials | 1 | 179 (45.9) | 149 (35.1) | 423 (55.7) | 751 (47.7) |
| 2 | 172 (44.1) | 162 (38.2) | 253 (33.3) | 587 (37.3) | |
| 3 | 25 (6.4) | 477 (11.1) | 62 (8.2) | 134 (8.5) | |
| 4 or more | 14 (3.6) | 66 (15.6) | 21 (2.8) | 101 (6.4) | |
| Indication for antimicrobial use | Upper respiratory tract infection | 3 (0.8) | 1 (0.2) | 54 (6.7) | 58 (3.7) |
| Lower respiratory tract infection | 195 (50.0) | 127 (30.0) | 311 (41.0) | 633 (40.2) | |
| Tuberculosis | 30 (7.7) | 46 (10.8) | 7 (0.9) | 83 (5.3) | |
| Meningitis/encephalitis | 10 (2.6) | 22 (5.2) | 11 (1.4) | 43 (2.7) | |
| Skin and soft tissue infection | 23 (5.9) | 8 (1.9) | 60 (7.9) | 91 (5.8) | |
| Gastroenteritis | 16 (4.1) | 19 (4.5) | 41 (5.4) | 76 (4.8) | |
| Urinary tract infectione | 15 (3.8) | 24 (5.7) | 115 (15.2) | 154 (9.8) | |
| Endocarditis | 0 | 3 (0.7) | 3 (0.4) | 6 (0.4) | |
| Leptospirosis | 0 | 0 | 49 (6.4) | 49 (3.1) | |
| Malaria | 0 | 7 (1.6) | 0 | 7 (0.4) | |
| Surgical prophylaxis | 1 (0.2) | 0 | 5 (0.6) | 6 (0.4) | |
| Medical prophylaxis | 3 (0.8) | 14 (3.3) | 0 | 17 (1.1) | |
| Bacteremia | 2 (0.5) | 2 (0.5) | 0 | 4 (0.2) | |
| Fever only (no other indication) | 8 (2.0) | 0 | 3 (0.4) | 11 (0.7) | |
| Other | 42 (10.8) | 67 (15.8) | 39 (5.1) | 148 (9.4) | |
| No clear indication | 41 (10.5) | 140 (33.0) | 85 (11.2) | 266 (16.9) | |
| Duration of therapy (days) | 6 (4–8) | 5 (3–9) | 4 (3–5) | 4 (3–7) | |
| Microbiology/infectious diseases consulted or provided input | Yes | 92 (23.6) | 2 (0.5) | 8 (1.1) | 102 (6.5) |
| No | 107 (27.4) | 193 (45.5) | 735 (96.8) | 1035 (65.8) | |
| Service not available | 0 | 226 (53.3) | 0 | 226 (14.4) | |
| Missing | 191 (49.0) | 3 (0.7) | 16 (2.1) | 210 (13.4) | |
| Creatinine obtained before or on same day starting antimicrobial usef | Yes | 249 (63.8) | 212 (50.0) | 406 (53.5) | 867 (55.1) |
| No | 34 (8.7) | 100 (23.6) | 247 (32.5) | 381 (24.2) | |
| Missing | 7 (0.6) | 5 (0.7) | 10 (0.8) | 22 (0.7) | |
| Culture result | Yes | 29 (7.4) | 33 (7.8) | 127 (16.7) | 189 (12.0) |
| No | 239 (61.3) | 386 (91.0) | 588 (77.5) | 1213 (77.1) | |
| Missing | 122 (31.3) | 5 (1.2) | 44 (5.8) | 171 (10.9) | |
| Discharged/ transferred on antimicrobials | 59 (15.1) | 148 (34.9) | 132(17.4) | 339 (21.6) | |
a
Narrow-spectrum penicillin includes amoxicillin, ampicillin, dicloxacillin, nafcillin, oxacillin, or cloxacillin.
b
Macrolides include erythromycin, azithromycin, or clarithromycin.
c
Antimalarial drugs include artemether-lumefantrine, artesunate, or quinine.
d
Other antimicrobials include trimethoprim and sulfamethoxazole, clindamycin, piperacillin/tazobactam, ampicillin/cloxacillin, albendazole, tinidazole, nitrofurantoin, and piperacillin.
e
Urinary tract infection includes cystitis and pyelonephritis.
f
Missing means no record of either antimicrobial therapy date or creatinine obtained date.