Table 2.

Indicators that have been used among in-patients in hospitals across Africa to assess the prescribing of antibiotics.

Indicator	References
Activity/Performance Indicators
% of in-patients prescribed antibiotics in a single PPS/ over specific time periods, e.g., successive waves of COVID-19	[19,61,112,172]
% of antibiotics prescribed by defined daily doses (DDDs), e.g., DDDs/1000 patient-days in a PPS or over a specified time	[171,173,174,175]
% of a course of antibiotics prescribed (duration) in accordance with agreed guidance/ Days of antibiotic therapy per 1000 patient-days	[166,176]
% of antibiotics administered to in-patients within the first hour of prescribing within a designated period of time	[177]
% of patients where the indication for prescribing and/ or stop and review dates are included in patients’ notes	[15,19,76,81,114,168,169,178,179]
% oral vs. IV antibiotics (including as part of de-escalation policies)	[15,76,82,114,166,168,171,178,179,180,181]
% of missed doses documented in patients’ notes, e.g., as part of a PPS	[19,148]
% of antibiotics prescribed by their international non-proprietary name, e.g., as part of a PPS	[182,183]
% compliance to agreed process measures surrounding AMS	[184]
% of patients prescribed antibiotics within the country’s essential medicine list over an agreed period of time	[61,171,180,182,183]
Process quality indicators
% of in-patients prescribed antibiotics in adherence to agreed guidelines within a specified time period/part of a PPS	[81,112,134,168,184,185,186,187,188,189,190,191]
% of patients prescribed a course of antibiotics in accordance with guideline duration recommendations within a specified time period/ part of a PPS	[166,176]
% of patients where cultures are taken and sent for analysis to guide antibiotic prescribing/ targeted therapy within a specified time period/ part of a PPS	[76,114,169,192]
% of antibiotics prescribed based on the AWaRe classification/% reduction in the prescribing of target antibiotics, e.g., ‘Watch’ cephalosporins to potential ‘Access’ antibiotics (current target is 60% of current prescribing should be ‘Access’ antibiotics)	[60,76,81,193]
% of patients prescribed antibiotics post-operatively to prevent SSIs/% appropriate use of antibiotics to prevent SSIs during an agreed time period	[194,195]
% of key antibiotics available for prescribing/ Whether there are agreed therapeutic interchange policies in the hospital when there are likely to be shortages of standard antibiotics for the condition (over a specific time period)	[183,196]
% of all admitted patients with pneumonia to the hospital correctly classified and treated to agreed guidelines (over a specified time period)	[187,190]
Outcome Indicators
% SSIs following operations (over an agreed time period)	[160,194,197]
% Mortality rates (post-intervention versus pre-intervention) following changes in antimicrobial prescribing, e.g., reducing extensive antimicrobial prescribing post-surgery for SAP or reducing extensive prescribing of ‘Watch’ antibiotics	[175,176,193]

AMS: Antimicrobial Stewardship; DDDs: Defined Daily Doses; SAP: Surgical Antibiotic prophylaxis; SSIs: surgical site infections.