Prevalence and Indications for Antibiotic Prescription Among Patients Hospitalized with COVID-19 Disease at Kenyatta National Hospital, Kenya

Author(s): Kenneth Thokozani Nyoni, Daniel Mokaya, George Alliwa Makalliwa

Background: Overuse of antibiotics results in escalating the burden of antimicrobial resistance. Reports indicate high use of antibiotics (72%) among hospitalized COVID-19 patients despite low prevalence (8%) of bacterial infections. The 2021 Kenya Clinical Management for COVID-19 guidelines strongly discourage empirical use of antibiotics. Objectives: This study determined antibiotic prescription prevalence and indications among hospitalized COVID-19 patients Kenyatta National Hospital.

Materials and Methods: Using a data abstraction form, this cross-sectional study included data from 283 patient files obtained from COVID 19 patient archived files at Kenyatta National Hospital (KNH). Data was analyzed using frequency and percentages. A chi-square analysis was done to compare antibiotic prescriptions for patients with bacterial infection and patients without a diagnosis of bacterial infection.

Results: The prevalence of antibiotic prescription among the patients hospitalized with COVID-19 disease at KNH was 73.5% (95% CI: 68.0%-78.5%) and the most prescribed antibiotics was Azithromycin to 40.4% (95% CI: 33.7% - 47.4%) of the participants. Forty-six percent of the antibiotic prescriptions had no indication. About 33% of the participants had a clinical diagnosis of bacterial infection as an indication for antibiotic prescription, and 22 (7.8%) participants had a microbiology test result.

Conclusion: The findings of this study showed that the prevalence of antibiotic prescription among patients hospitalized with COVID-19 disease at KNH is high. Most antibiotic prescriptions had no indications, suggesting inappropriate antibiotic use. New policy and practice guidelines to support antibiotic stewardship programs are needed to reduce inappropriate antibiotic use.