Antibiotic prescribing habits among primary healthcare workers in Northern Nigeria: a concern for patient safety in the era of global antimicrobial resistance

Abstract

INTRODUCTION: Antibiotic overprescribing is associated with antibiotic resistance worldwide but worst in developing nations. Minimal information exists on the antibiotic prescribing habits of essentially all cadres of healthcare workers in Nigeria, but particularly primary healthcare (PHC) workers. Our aim was to explore antibiotic prescribing habits of Nigerian primary healthcare workers in the context of increasing antibiotic resistance which has a direct effect on healthcare associated infections (HCAIs) and patient safety worldwide. METHODS: a questionnaire-based cross-sectional study was conducted among 442 primary healthcare workers across three Northern Nigerian states of Gombe, Sokoto and Kwara. Data obtained was analysed using SPSS version 20. RESULTS: antibiotic prescription rate was 98.2%. The most commonly prescribed antibiotics were amoxicillin (71.7%) and ampicillin/cloxacillin (70.1%) while the least was meropenem (4.1%). Major indicators of antibiotics abuse include unconfirmed typhoid fever (96.1%), non-specific vaginal discharge (95.4%), fresh trauma wound (91.3%), non-specific diarrhoea (87.1%) and common cold (85.9%). Additionally, about one-third of the respondents also routinely prescribe antibiotics to healthy birds (31.5%) and animals (18.3%). Identified reasons attributed to antibiotic overprescribing from the participants´ perspectives include lack of awareness (87.0%), lack of penalty (79.4%), desire to help patients (76.5%), pressure from sales representatives (61.0%) and patients´ pressure (58.3%). Overall, majority (85.8%) of respondents agrees that overprescribing is a cause of antimicrobial resistance. CONCLUSION: overprescribing of antibiotics is common among PHC workers and could contribute significantly to the rising scourge of antimicrobial resistance and poses a threat to patient safety and associated increased burden of HCAIs.