Situational analysis of antibiotic prescriptions in Kenyan neonatal units for antimicrobial stewardship: a retrospective longitudinal study

Journal article

Background
High antibiotic use in neonatal units may drive antimicrobial resistance and cause harm including mortality. We used data from 22 Kenyan neonatal units to (1) describe the proportion with antibiotic prescriptions at admission; (2) assess the predictors of non-first line antibiotic prescription; (3) estimate antibiotic use, and (4) explore postadmission antibiotic switching.
Methods
Retrospective longitudinal study from 1st September 2020 to 31st October 2023. Antibiotics were classified as first line (penicillin plus gentamicin only), third generation cephalosporins (ceftazidime or ceftriaxone) or others. The proportion of antibiotic prescriptions were computed, and a multilevel logistic regression model used to analyse predictors of non-first line prescription. Antibiotic use was quantified by days of therapy (DOT) and length of therapy (LOT).
Findings
Most neonates–62.6% (51,883/82,834)- received at least one antibiotic prescription at admission. Overall, first line antibiotics constituted 86% (44,636/51,883) but third generation cephalosporin use reached 100% in two facilities temporarily. The odds of non-first line prescription was greatest for outborn neonates (Odds ratio 2.27, 95% CI 2.12–2.43) while the estimated antibiotic consumption was 418 (389–500) per 1000 patient days by LOT and 744 (691–869) by DOT. From exploratory data post admission switching was most commonly to third generation cephalosporins.
Interpretation
There is a high use of antibiotics potentially related to severity of illness at admission. Adherence to national guidelines for first line antibiotics is however generally high. Estimation of neonatal antibiotic prescription patterns and use over time and place is feasible and will be important in assessing the effectiveness of antimicrobial stewardship in Kenya and elsewhere in reducing antimicrobial resistance.
Funding
This work was funded by the Wellcome Trust.

Authors: Aluvaala, J; Tuti, T; Ogola, M; Lim, C; Cavany, S

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: EClinicalMedicine
• Volume: 82
• Article number: 103156
• Place of publication: England
• Publication date: 2025-03-25
• Acceptance date: 2025-02-27
• DOI: 10.1016/j.eclinm.2025.103156
• EISSN: 2589-5370
• Pmid: 40212050
• Language: English
• Keywords: antibiotic use: antimicrobial stewardship; neonatal; antibiotics