Table 1.

Extent of prolonged antimicrobial prophylaxis to prevent SSIs across sub-Saharan Africa.

Country	Year (and Reference)	Findings
Low Income *
Burkina Faso	2019 [154]	Prolonged administration of antibiotics was common (>2 days) among 62 patients in this PPS study to help prevent SSIs Antibiotics administered for >2 days in 87.1% of cases
Ethiopia	2018 [155]	Among patients who were prescribed antibiotics postoperatively (80 out of 90 patients) for SAP, 88.8% were prescribed for >1 day post-operatively The majority of patients (84.5%) received ceftriaxone (W)
	2018 [156]	79.1% of surveyed SAP patients (153 patients) were prescribed antibiotics for 2 days or more 34.7% were prescribed antibiotics for >5 days Approximately 84% of the patients were prescribed ceftriaxone (W) either alone or in combination
	2022 [157]	82.6% of 218 patients undergoing surgery had antibiotics prescribed for >1 day to prevent SSIs The average number of antibiotics prescribed per patient was 1.32 Ceftriaxone (54.7% of antibiotics—W) was the widely prescribed antibiotic for SAP
Rwanda	2019 [158]	Nearly all women who received antibiotics pre-operatively (66.7% of 550 women undergoing a caesarean section) had antibiotics post operatively to reduce SSIs Typically, a single dose of 1 g ceftriaxone (W) was given within 1 h before incision
Tanzania	2020 [159]	Out of 57 patients, 33% had antibiotics prescribed for SAP for 2–3 days and 56% for >3 days Ceftriaxone (W) was the most prescribed antibiotic for SAP (n = 28; 49%)
	2020 [160]	Typically, SAP was administered for 3 days post operatively prior to the intervention followed by oral antibiotics, i.e., 3 days of intravenous ceftriaxone (W) plus metronidazole (A), followed by oral penicillins (A) plus metronidazole for at least 5 days—timing was highly variable ranging from 1 to 24 h post-caesarean section This appreciably changed following the education of key stakeholders and monitoring of future prescribing habits with patients. A pre-operative prophylaxis with 1 g ampicillin (A) was administered 30–60 min before the incision with antibiotics only prescribed post-operatively for treatment Combined with training, overall a reduction in SSIs despite limiting antibiotic prescribing post-operatively among 320 studied patients Overall, the educational intervention provided savings of EUR 1500 for the hospital with reduced antibiotic prescribing
	2021 [81]	97% of patients undergoing surgery (96 patients overall) had antibiotics prescribed for SAP for >1 day
Uganda	2020 [161]	Most patients received prolonged antibiotic therapy for SAP after their surgery (907 patients) Combination of ceftriaxone (W) and metronidazole (A) was the most common regimen (609/907 patients—67.1%)
	2021 [81]	97.1% of antibiotics prescribed for SAP were for >1 day (170 patients overall)
	2022 [13]	98.4% of patients surveyed had multiple doses of antibiotics for SAP for >1 day (301 patients overall) Ceftriaxone (W) and metronidazole (A) were the principal antibiotics prescribed in this PPS study including for prophylaxis
Low-Middle Income *
Congo	2020 [162]	69.1% of surveyed patients (265 patients in total) were prescribed antibiotics for 3 days or longer post operatively Ampicillin (A) was the most frequent antibiotic prescribed (43.8% of patients) followed by cloxacillin (13.2%) (A), gentamicin (9.4%) (A) and ceftriaxone (9.1%) (W) either alone or in combination
Ghana	2019 [163]	88.4% of patients (out of 121 patients) were prescribed antibiotics for >1 day to prevent SSIs 9.9% of patients were prescribed antibiotics for one day with only 1.6% of patients receiving a single dose of antibiotics to prevent SSIs The most commonly prescribed antibiotics for SAP were cephalosporins (28.9% of patients) and co-amoxiclav (A) (28.1%)
	2020 [76]	Antibiotics for SAP were typically prescribed for >1 day in 69.0% of patients in one of the surveyed hospitals and 77.0% in the other (26 patients overall)
	2021 [81]	75.5% of antibiotics prescribed for SAP were for >1 day (478 patients overall)
	2021 [164]	78.0% of 318 patients surveyed undergoing surgery received antibiotics for >1 day to prevent SSIs 13.0% of those surveyed were prescribed antibiotics for one day post operatively, and only 9% received a single dose
	2022 [141]	Duration of antibiotics to prevent SSIs among those surveyed was 6.9 ± 2.1 days The most common antibiotics prescribed were a combination of cefuroxime (W) and metronidazole (56.1%, n = 335) (A) followed by co-amoxiclav (14.2%) (A)
Kenya	2017 [165]	In all 69 patients surveyed, the duration of SAP ranged from one to three days Ceftriaxone (W) was the most common antibiotic prescribed for SAP (78% of patients)
	2018 [78]	The average number of doses of antibiotics for SAP in surveyed patients was 19.1 The most frequently prescribed antibiotics on the surgical wards (most for SAP) were third-generation cephalosporins
	2018 [166]	Most antibiotics prescribed in the surgical ward of this hospital were for prophylaxis (56.3%) vs. treatment (43.7%) The mean duration of antibiotic administration in the surgical ward was 6 ± 4.7 days, with most patients prescribed antibiotics for 1–3 days (30.2%) or 4–6 days (40.9%) The most prescribed antibiotics among those surveyed were ceftriaxone (W) and flucloxacillin (A) either alone or in combination with metronidazole (A)
	2019 [79]	76.9% of surveyed patients with antibiotics for SAP were prescribed these for >1 day with only 9.6% of patients administered a single dose for SAP
Nigeria	2016 [167]	Prolonged administration of antibiotics to prevent SSIs was common among 100 patients undergoing SAP along with the prescribing of broad-spectrum antibiotics including third-generation cephalosporins
	2017 [168]	Antibiotic prescriptions for SAP were given for >1 day in 95.0% of 277 patients undergoing surgery Ceftriaxone (28.0% of situations) (W), metronidazole (20.0%) (A) and cefuroxime (17.0%) (W) were the most prescribed antibiotics for SAP
	2020 [82,169]	All antibiotics prescribed for SAP were for >1 day in both studies In the study of Abubakar, nitroimidazoles including metronidazole (33.7% of total prescriptions), third-generation cephalosporins (20.8%), and combinations of penicillins and beta-lactamase inhibitors (10.9%) (A) were the most prescribed antibiotics
	2020 [114]	89% of surveyed patients (127 undergoing prophylaxis) were given antibiotics for >24 h to help prevent SSIs
	2021 [16]	94.8% of 96 patients had antibiotics administered for longer than 24 h to prevent SSIs 4.2% had antibiotics administered for one day and only 1.0% of patients were prescribed one dose of SAP Metronidazole (A), cefuroxime (W), ceftriaxone (W) and ciprofloxacin (W) were the most prescribed antibiotics in the surgical wards
	2022 [14]	All 63 patients were prescribed antibiotics for SAP post-operatively—24 h in 23.8% of patients and >1 day in 76.2% of patients
Zambia	2021 [81]	96.5% of patients undergoing surgery had antibiotics prescribed for SAP for >1 day (83 patients overall)
Upper-Middle Income *
Botswana	2018 [170]	Prolonged administration of antibiotics was common for SAP with a mean (SD) duration of 5 (+/− 2.6) days, greatest for emergency surgery (72.7% of occasions among 104 patients) The most commonly prescribed antibiotics were cefotaxime (80.7% of situations) (W), metronidazole (63.5%) (A) and cefradine (A) (13.6%)
	2019 [19]	Extended prophylaxis for SAP (>1 day) was common—greatest among Primary hospitals (100% of 2 patients surveyed) and Tertiary hospitals (100% of 58 patients surveyed) versus District hospitals (90.3% of 31 patients surveyed) and Specialist hospitals (66.7% of 27 patients surveyed) Principal antibiotics prescribed for SAP were ampicillin (26.77% of occasions) (A), amoxicillin (24.41%) (A), metronidazole (17.32%) (A) and ceftriaxone (7.09%) (W)
South Africa	2021 [171]	In 73.2% of cases surveyed (n = 108 patients) for SAP were prescribed antibiotics for >1 day Cefazolin (A) was the most commonly prescribed antimicrobial (45.5% of cases) for SAP followed by co-amoxiclav (22.3% of cases) (A), ceftriaxone (9.8%) (W) metronidazole (5.4%) (A)
	2022 [61]	In 66.7% of paediatric cases (10 out of 15 patients), antibiotics for SAP were prescribed for >1 day

A and W: Access and Watch (AWaRe classification); SAP: Surgical Antibiotic Prophylaxis; SSIs: Surgical Site Infections; * World Bank Status (Based on [59]).