Health system and treatment regimen determinants of delayed first-dose antibiotic administration in hospitalized adults in two public health facilities in Kampala, Uganda
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Background
Delayed first-dose antibiotic administration among hospitalized adults partly contributes to poor treatment outcomes. However, the operational drivers of such delays remain poorly characterized in low-resource settings. We sought to delineate the possible operational drivers of these delays, and suggest potential interventions to improve timely antibiotic administration.
Methods
We conducted a prospective cohort study among 606 adult inpatients with suspected or confirmed bacterial infections at two public health facilities in Uganda. Delayed administration was defined as administration of the first antibiotic dose >48 h after prescription. Data were obtained through interviewer-administered questionnaires and medical record review. Data analysis was performed using penalized multivariable logistic regression using Firth’s bias-reduction method to identify factors independently associated with delay.
Results
Among 606 participants, 36 (6%) experienced delayed first-dose antibiotic administration. Participants initiated on three antibiotics had significantly higher odds of delay compared with those prescribed monotherapy (aOR 5.27, 95% CI 1.85–14.97). External medication procurement demonstrated a borderline inverse association with delayed administration (aOR 0.24, 95% CI 0.06–1.03). Sensitivity analysis using a > 24-hour threshold showed directionally consistent findings. In bivariate analyses, participants reporting inadequate household income had lower odds of delayed administration. Generally, patient demographic characteristics were not associated with delay.
Conclusions
Although delayed first-dose antibiotic administration was uncommon, it was driven by modifiable health system inefficiencies and regimen complexity. Treatment regimen complexity was associated with delay, highlighting opportunities to strengthen inpatient antibiotic delivery systems through streamlined multi-drug prescribing and administration workflows. Larger multicenter studies are warranted to assess the clinical implications of delayed antibiotic administration in resource-limited settings.
