Antibiotic Consumption Patterns among Outpatients at a Cardiac Tertiary Hospital in Tanzania
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Background
Outpatient encounters are significant contributors to avoidable antibiotic exposure. However, the dispensing-based outpatient consumption data for Tanzania are limited. Most national estimates rely on import or sales data that do not reflect patient-level use. Cardiovascular clinics are particularly relevant because cardiopulmonary symptom overlap can lead to precautionary prescribing.
Methods
We conducted a retrospective dispensing-based utilization analysis of cardiovascular outpatients at the Jakaya Kikwete Cardiac Institute (JKCI) in Dar es Salaam, Tanzania, from July 2017 to June 2022. Systemic antibacterial agents were mapped to the World Health Organization anatomical therapeutic chemical/defined daily dose (WHO ATC/DDD) and expressed as defined daily doses per 100 outpatients per day. Consumption patterns were summarized by fiscal year, molecule, ATC level 3, and WHO Access/Watch/Reserve (AWaRe) category. Monthly consumption was decomposed to evaluate trends and seasonality.
Results
A total of 11,586 outpatients received at least one systemic antibiotic during the study period. Annual outpatient antibiotic utilization remained low and stable, ranging from approximately 0.27 to 0.38 DDD per 100 outpatients per day across fiscal years, with a cumulative total of 1.68 DDD per 100 outpatients per day across the five years. Consumption was dominated by beta-lactam/penicillin antibiotics, with Access antibiotics accounting for 48.5% of cumulative exposure, followed by Watch antibiotics (45.5%) and minimal Reserve use (5.9%). However, the Access proportion was below the WHO Access-60 benchmark for optimal outpatient use. Time-series decomposition revealed a modest upward trend, peaking in early 2021, accompanied by a recurring seasonal pattern of monthly use.
Conclusion
Outpatient antibiotic utilization at JKCI was quantitatively low, yet showed persistent exposure dominated by Access antibiotics. Dispensing-based outpatient surveillance is feasible and should be integrated into routine stewardship dashboards to target avoidable outpatient antibiotic use.
