Guideline Recommendations for Empirical Antimicrobial Therapy: An Appraisal of Research Evidence for Clinical Decision-Making in Ethiopia

Balew Arega; Asnake Agunie; Abraham Minda; Amdemeskel Mersha; Alazar Sitotaw; Getachew Weldeyohhans; Ayele Teshome; Kelemework Adane; Getachew Mengistu

doi:10.1007/s40121-020-00308-3

Guideline Recommendations for Empirical Antimicrobial Therapy: An Appraisal of Research Evidence for Clinical Decision-Making in Ethiopia

Infect Dis Ther. 2020 Sep;9(3):451-465. doi: 10.1007/s40121-020-00308-3. Epub 2020 Jun 22.

Authors

Balew Arega¹, Asnake Agunie², Abraham Minda², Amdemeskel Mersha², Alazar Sitotaw², Getachew Weldeyohhans², Ayele Teshome², Kelemework Adane³, Getachew Mengistu⁴

Affiliations

¹ Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia. balewmlt@gmail.com.
² Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia.
³ Meklle University, College of Health Science, Mekelle, Ethiopia.
⁴ Debere Markos University, College of Health Science, Debre Markos, Ethiopia.

Abstract

Introduction: The rapid spread of drug resistance is forcing standard treatment guidelines (STGs) to become more appropriate with due consideration of the evidence on the antimicrobial resistance (AMR) situation in Ethiopia. Therefore, we aimed to assess the local AMR recommendations in the STGs for empirical antibacterial prescriptions for the five common infectious syndromes. We also determined the quality of AMR reviews conducted in the country.

Methods: We conducted a review of the STGs used in the health centers, general hospitals, and primary hospitals in Ethiopia and assessed the AMR recommendations in STGs for empirical antibacterial prescriptions for community-acquired pneumonia (CAP), urinary tract infection (UTI), tonsillopharyngitis, acute otitis media (AOM), and bacterial dysentery. Next, we performed an overview of AMR reviews published in Ethiopia. We used the MEDLINE/PubMed, Embase, Cochrane Library, and Google Scholar databases to identify AMR reviews. The review characteristics were extracted. We also evaluated the quality of each included AMR review using a measurement tool to assess the systematic review scale (AMSTAR 2).

Results: A total of 6 STGs and 12 AMR reviews conducted in the country were included. The choice of empirical antibacterials for similar infectious syndromes (and editions) was comparable across the three levels of the health care system. None of the STGs evaluated included the local AMR recommendations for empirical antibacterial prescriptions for five common infectious syndromes. Of all the AMR reviews included, 75% had low and below methodologic quality, and none had a high-quality score using the AMSTAR 2 tool.

Conclusion: Standard treatment guidelines did not consider local AMR recommendations for empirically prescribing antibacterials for common infectious syndromes. The AMR reviews published in the country produced poor methodologic quality evidence for clinical applications. This highlights the need to improve the methodologic quality to provide the best available evidence for clinical decision-making and curb the ongoing AMR in Ethiopia.

Trial registration: Retrospectively registered (15/07/2020).

Keywords: Antimicrobial resistance; Ethiopia; Treatment guideline.

Publication types

Review