In the last decades, there has been an escalating consumption of antibiotics with the number of antibiotic prescriptions increasing worldwide. Overuse or inappropriate use of antibiotics has resulted in a major increase in the development of multi-drug resistant pathogens. Antimicrobial resistance is one of the world’s most serious public health problems with great implication in terms of morbidity, mortality, and costs. To date, there has been no formal antibiotic use study conducted in the West Wollega zone of Ethiopia to assess antibiotic utilization. The objective of this study was to determine the pattern of antibiotic use in two hospitals in the West Wollega zone of Ethiopia, namely Gimbie Adventist Hospital and Nedjo Hospitals, using drug utilization metrics and the costs associated. In addition it was to assess the correlation between diagnosed infectious diseases and antibiotic prescriptions. This study was a cross-sectional, retrospective, descriptive review of antibiotic usage in the two hospitals in the year 2007. Prescriptions dispensed in the first month of each quarter of 2007 were reviewed. The number of prescriptions screened, antibiotic courses started, antibiotic days by specific agent and overall, the cost of individual and all antibiotics, the number and type of infectious diseases diagnosed were collected from which core drug use indicators were calculated. The correlation between infectious disease diagnosed and the antibiotic days prescribed were analyzed. A total of 18568 antibiotic and non-antibiotic prescriptions were reviewed retrospectively in the four months of the study period, 47 percent of which contained at least one antibiotic. The average number of antibiotics per prescription was 1.33 and 1.09 whilst the percentage of injectable antibiotics prescribed was 83.2 percent and 3.76 percent to outpatients and inpatients respectively. Antibiotics prescribed from the Essential Drug List (EDL) and List of Drugs for District Hospital (LDDH) were 63.0 percent, 74.8 percent, and 90.8 percent and 76.1 percent for outpatients and inpatients respectively. 98.6 percent of outpatient and 97.0 percent inpatient prescribed antibiotics were actually dispensed. Penicillins and quinolones were the most prescribed antibiotics in both inpatient and outpatient departments constituting 43.46 percent and 24.08 percent respectively. The antibiotic utilization ratio, incidence of outpatient antibiotic use, incidence of inpatient antibiotic use, the number of Defined Daily Doses (DDD)/1000inhabitants/year and DDD/100 Occupied Bed Days (OBD) for the zone was 0.16, 17.25, 23.56, 158.61, and 70 respectively. Antibiotic cost constituted 33.7 percent of all expenditure on drug, cost of antibiotic per patient care day and cost per antibiotic day was 3.84 Ethiopian Birr (ETB) ($0.40) and 6.29 ETB ($0.66) respectively. The correlation between infectious diseases diagnosed and antibiotic prescription shows significant variation. At outpatient departments alone an average number of antibiotic courses started was 2.7 at Gimbie Adventist Hospital and 7.6 for Nedjo Hospital. When overall antibiotic days prescribed and required was compared in both hospitals, there were 2.4 and 5 times more antibiotic days prescribed than were required for Gimbie and Nedjo Hospitals respectively. This suggests that the overuse of antibiotic is worse in the government hospital (Nedjo Hospital) than in the mission hospital (Gimbie Adventist Hospital). This study suggested that there was overuse of antibiotics in the West Wollega hospitals although further investigation is needed to identify its underlying causes and nature. It is recommended that the health personnel, the hospital management, the zonal and regional Health Bureau, the regulatory bodies and Non-Governmental Organizations (NGOs) work hand-in-hand to promote the rational use of antibiotics in this region so that the consequences and financial cost of antimicrobial resistance can be prevented.

Lee, Ching Ching. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 90-103). / Abstracts in English and Chinese. / Acknowledgments --- p.i / Abstract --- p.ii / 論文摘要 --- p.iv / Table of Contents --- p.vi / List of Tables --- p.x / List of Figures --- p.xi / Chapter Chapter 1 --- Introduction / Chapter 1.1. --- Quinolone Antimicrobial Agents --- p.1 / Chapter 1.1.1. --- Development --- p.1 / Chapter 1.1.2. --- Mode of action --- p.3 / Chapter 1.1.3. --- Mechanisms of resistance to quinolones --- p.4 / Chapter 1.1.3.1. --- Target genes mutations --- p.4 / Chapter 1.1.3.2. --- Decreased intracellular quinolone accumulation --- p.5 / Chapter 1.1.3.3. --- Plasmid-mediated quinolone resistance --- p.6 / Chapter 1.2. --- Plasmid-mediated Quinolone Resistance Genes (qnr) --- p.8 / Chapter 1.2.1. --- Discovery of qnrA genes --- p.8 / Chapter 1.2.2. --- Discovery of qnrS genes --- p.9 / Chapter 1.2.3. --- Discovery of qnrB genes --- p.10 / Chapter 1.2.4. --- Discovery of qnrC genes --- p.11 / Chapter 1.2.5. --- Discovery of qnrD genes --- p.12 / Chapter 1.2.6. --- Origins of qnr genes --- p.12 / Chapter 1.2.7. --- Qnr proteins and mode of action --- p.14 / Chapter 1.2.8. --- Epidemiology and quinolones resistance activity of qnr genes --- p.16 / Chapter 1.2.9. --- Epidemiology of fluoroquinolone-resistant Enterobacteriaceae --- p.17 / Chapter 1.2.10 --- Multidrug-resistant in extended-spectrum-B-lactamase- and AmpC-producing Enterobacteriaceae --- p.19 / Chapter 1.3. --- Background of Study --- p.20 / Chapter 1.4. --- Objectives of Study --- p.21 / Chapter Chapter 2 --- Materials & Methods / Chapter 2.1. --- Study Design --- p.22 / Chapter 2.2. --- Antimicrobial Susceptibility Testing --- p.24 / Chapter 2.2.1 --- Bacterial isolates --- p.24 / Chapter 2.2.2. --- Screening for ESBL and AmpC production by disk diffusion test --- p.24 / Chapter 2.2.3. --- Determination of minimal inhibitory concentrations (MICs) --- p.25 / Chapter 2.3. --- "Detection of qnrA, qnrB and qnrS Genes by Multiplex PCR" --- p.27 / Chapter 2.3.1. --- Total DNA preparation --- p.27 / Chapter 2.3.2. --- "Multiplex PCR assay for qnrA, qnrB and qnrS genes detection" --- p.27 / Chapter 2.3.3. --- Agarose gel electrophoresis --- p.29 / Chapter 2.4. --- "Detection of TEM-, SHV-, CTX- and PMAmpC Type B-Lactamase Genes by PCR" --- p.30 / Chapter 2.5. --- PCR Assays for Further Genotypic Characterization Purpose --- p.32 / Chapter 2.5.1. --- PCR assay to amplify qnrB genes --- p.32 / Chapter 2.5.2. --- PCR assay to amplify qnrS genes --- p.33 / Chapter 2.5.3. --- "PCR assays for genotypic characterizations of the co-existed blaTEM, blaSHV, blaCTX-M and PMAmpC genes of all qnr-positive isolates" --- p.33 / Chapter 2.5.3.1. --- Genotypic characterizations of the co-existed bla-TEM and genes --- p.33 / Chapter 2.5.3.2. --- PCR assays to amplify the co-existed blaCTX_M genes --- p.33 / Chapter 2.5.3.3. --- PCR assay to amplify the co-existed PMAmpC genes --- p.34 / Chapter 2.5.4. --- Sequencing reaction --- p.36 / Chapter 2.5.4.1. --- Purification of PCR product and sequence determination --- p.36 / Chapter 2.5.4.2. --- Sequence analysis --- p.37 / Chapter 2.6. --- Collection of Clinical Data --- p.38 / Chapter 2.6.1. --- Demographics and clinical data --- p.38 / Chapter 2.6.2. --- Definitions --- p.38 / Chapter 2.6.3. --- Data analysis --- p.40 / Chapter Chapter 3 --- Results / Chapter 3.1. --- Bacterial Isolates --- p.41 / Chapter 3.2. --- "Demographics, Medical History, Clinical Features and Clinical Outcomes of Patients" --- p.42 / Chapter 3.3. --- Antimicrobial Susceptibility Testing --- p.44 / Chapter 3.4. --- Detection of qnr Genes --- p.48 / Chapter 3.4.1. --- "Detection of qnrA, qnrB and qnrS genes by multiplex PCR" --- p.48 / Chapter 3.5. --- Detection of ESBLs --- p.49 / Chapter 3.5.1. --- Detection of TEM- and SHV-type ESBLs --- p.49 / Chapter 3.5.2. --- Detection of CTX-M- type ESBLs --- p.51 / Chapter 3.6. --- Detection of PMAmpC Genes --- p.52 / Chapter 3.6.1. --- Detection of PMAmpC genes --- p.52 / Chapter 3.7. --- "The Distribution of qnr and bla Genes for TEM, SHV, CTX-M and PMAmpC" --- p.53 / Chapter 3.8. --- The Characteristics of qnr Isolates --- p.54 / Chapter 3.8.1. --- Genotypes of qnrB and qnrS --- p.54 / Chapter 3.8.2. --- Antimicrobial susceptibility of qnr isolates --- p.58 / Chapter 3.9. --- "The Associations of qnr Genes with Other Bacterial Resistance Genotypes, and the Clinical Characteristics and Outcomes of Patients" --- p.62 / Chapter 3.9.1. --- "Univariate analysis of the associations of qnr genes with other bacterial resistance genotypes, and the clinical characteristics and outcomes of patients" --- p.62 / Chapter 3.9.2. --- "Multivariate analysis of the associations of qnr genes with other bacterial resistance genotypes, and the clinical characteristics and outcomes of patients" --- p.65 / Chapter 3.9.2.1. --- "Multivariate analysis of the associations of qnr genes with other bacterial resistance genotypes, and the clinical characteristics of patients" --- p.65 / Chapter 3.9.2.2. --- "Multivariate analysis of the associations of mortality with qnr genes, bacterial resistance genotypes and other clinical characteristics of patients" --- p.66 / Chapter Chapter 4 --- Discussion / Chapter 4.1. --- Prevalences and Susceptibility of ESBL and PMAmpC in Bacteraemic Enterobacteriaceae Isolates --- p.67 / Chapter 4.2. --- Epidemiology of Plasmid-mediated Quinolone Resistance (qnr) Genes --- p.69 / Chapter 4.3. --- Genotypes of qnr-positive Isolates --- p.72 / Chapter 4.4. --- Antimicrobial Susceptibility of qnr-positive Isolates --- p.75 / Chapter 4.5. --- "The Associations of qnr Genes with Other Bacterial Resistance Genotypes, and the Clinical Characteristics of Patients" --- p.79 / Chapter 4.6. --- "The Associations of Mortality with qnr Genes, Bacterial Resistance Genotypes and Other Clinical Characteristics of Patients" --- p.80 / Chapter 4.7. --- Clinical Importance and Clinical Implications of qnr Genes --- p.82 / Chapter 4.8. --- Limitations of the Current Study --- p.85 / Chapter 4.9. --- Future Studies --- p.87 / Chapter 4.10. --- Conclusions --- p.89 / References --- p.90