The appropriateness of ceftriaxone utilization in government hospitals of Eastern Ethiopia: A retrospective evaluation of clinical practice

Abstract

Introduction: Drug use evaluation is a method of obtaining information to identify problems related to drug use and if properly developed, a means of correcting the problems. Ceftriaxone is among the most commonly utilized cephalosporins. Owing to a broad spectrum of activity and being used empirically, ceftriaxone has been used inappropriately posing a risk for development of antimicrobial resistance. This study is, therefore, designed to evaluate the appropriateness of ceftriaxone utilization in government hospitals in Harar town. Methods: A retrospective cross-sectional study was conducted in four government hospitals of Harar town by reviewing the medical records of 271 patients who received ceftriaxone from 1 January to 31 December 2016. Systematic random sampling was utilized to capture the medical records. Data were entered and analyzed using SPSS version 22. Results: From the 271 medical records reviewed majority of patients were from surgical ward (n\u2009=\u200985, 31.4%) followed by gynecology and obstetrics ward (n\u2009=\u200967, 24.7%). Demographically, the majority of the patients were female (n\u2009=\u2009142, 52.4%). Patients in the age group of 20–29\u2009years were dominant (n\u2009=\u200998, 36.2%). A total of 71 drugs were co-administered with ceftriaxone, the most common being metronidazole followed by tramadol. Among the co-administered drugs, unfractionated heparin (n\u2009=\u20096), warfarin (n\u2009=\u20095), and enoxaparin (n\u2009=\u20091) were found to have a moderate drug interaction with ceftriaxone. Ceftriaxone was commonly used for post-operative prophylaxis (n\u2009=\u200980, 27.5%) followed by for the management of pneumonia (n\u2009=\u200962, 21.3%). The result of ceftriaxone use evaluation showed that majority (n\u2009=\u2009190, 70.1%) were found to be inappropriate. The inappropriate utilization was primarily due to wrong indication (indications for which ceftriaxone was not the primary option) (n\u2009=\u2009114, 60.0%) followed by wrong duration (n\u2009=\u200954, 28.4%). Conclusion: Ceftriaxone was used inappropriately in more than two-thirds of the patients, with wrong indication and wrong duration contributing the majority. Inappropriate use of antibiotics may potentially lead to the emergence and spread of drug-resistant microorganisms and also ultimately exposes the patient to treatment failure, prolonged hospital stay, and higher cost of therapy.