Evaluation of Ceftriaxone utilization in internal medicine wards of general hospitals in Addis Ababa, Ethiopia: a comparative retrospective study

A total of 477 patient medication records (charts) from both hospitals were included
for analysis. Among these, 376 were from the public hospital and 101 were from the
private hospital. The proportion of ceftriaxone prescription out of all medical ward
admissions was 59 % and 49 % in the public and the private hospital respectively.
From the 376 patients in the public hospital, 204 (54.3 %) were female. Of the 101
patients in the private hospital, 68 (67.3 %) were male. Mean age of patients in the
public hospital was 44.6 years (±SD; 13.4) while in the private hospital it was 49.8 years
(±SD; 21.0). Majority of treatment duration was in the range of 2–7 days accounting
for 76.6 % and 89.1 % of the public and private hospital, respectively (Table 1). The median length of hospital stay was 11 and 6 days in the public and private
hospital, respectively.

Table 1. Age, gender distribution and length of stay of patients in the medicine wards of general
hospitals in Addis Ababa, January, 2014 (n?=?477)

Common indications of ceftriaxone in the hospitals

Ceftriaxone was commonly utilized for pneumonia, meningitis, sepsis and non-surgical
prophylaxis in both hospitals. It was also prescribed for hepatic disorders, UTI,
cellulitis, and diabetic foot ulcer, in the public hospital. Similarly in the private
hospital, ceftriaxone was indicated commonly for hepatic disorders, Urinary Tract
Infection (UTI), cellulitis, diabetic foot ulcer, and Acute Gastro Enteritis (AGE)
(Table 2).

Table 2. The most common diseases for which ceftriaxone was prescribed in the medicine wards
of general hospitals in AA, February, 2014 (n?=?477)

Frequently co-administered drugs with ceftriaxone in the hospitals

Among the drugs co-administered with ceftriaxone, maintenance fluids took the lead
in both hospitals, the proportion being twofold in the private hospital compared to
the public hospital (72.28 % vs. 35.37 %). Metronidazole and anti-TBs in the public
hospital whereas diclofenac and metoclopramide in the private hospital was the other
common co-prescribed drugs (Table 3).

Table 3. The most frequently co-administered drugs with ceftriaxone in the medicine wards of
general hospitals in AA, February, 2014 (n?=?477)

Overall STG compliance of ceftriaxone therapy

One hundred ninety two of the 376 patients’ charts (48.9 %) in the public hospital
were found to be complying for an overall evaluation of indication, dose, and frequency
of administration and duration of ceftriaxone treatment according to the 2010 Standard
Treatment Guideline (STG) of Ethiopia for general hospitals. Using a similar procedure,
45 of the 101 patients (44.6 %) who were administered with ceftriaxone in the private
hospital were found to comply with the guideline.

Of the total 192 patient charts identified as inappropriate in the public hospital,
86 (44.8 %) was wrong indication of ceftriaxone as per the guideline whilst in 106
(55.2 %) cases were noted to show differences in dose, route, frequency or duration
of administration between practice and the Guideline (Fig. 1). Wrong uses of ceftriaxone in the assessments of hepatic disorders, non-surgical
prophylaxis, abscess, Chronic Obstructive Pulmonary Disease (COPD), wound, gastroenteritis,
Bronchitis and upper gastro intestinal bleeding for which the guideline recommends
no indication of the drug was noticed in the study.

Fig. 1. Proportion of Overall compliance use of ceftriaxone among medicine wards of general
hospitals in AA, February, 2014 (n?=?250)

In addition, deviation in duration of treatments for pneumonia, sepsis, meningitis,
UTI, cellulitis and diabetic foot ulcer were noted (Table 2). Other than duration, appropriate doses were not mentioned in the treatment of pneumonia,
meningitis, and sepsis.

Factors associated with STG compliant use of ceftriaxone

From the results of the binary logistic regression, it was found that the likelihood
of appropriate ceftriaxone use increased with days of hospital stay in both the public
and the private hospital (AOR?=?6.00; 95 % CI [3.40–10.80]), (AOR?=?3.30; 95 % CI,
[1.00–9.12]). This association works even when days of hospital stay increase beyond
14 days in the public hospital (AOR?=?5.58; 95 % CI, [3.10–10.00]) while it failed
to show statistical significance in the private hospital (AOR?=?3.50; 95 % CI, [0.75–16.58]).
Other variables namely, age, sex, co morbidity and presences of co administered drugs
were not associated with appropriateness (Table 4).

Table 4. Factors associated with appropriateness of ceftriaxone utilization in the medicine
wards of general hospitals in AA; February 2014 (n?=?477)