Antibiotic prescribing practice and adherence to guidelines in primary care in the Cape Town Metro District, South Africa

J Gasson, M Blockman, B Willems


Background. Knowledge of antibiotic prescribing practice in primary care in South Africa is limited. As 80% of human antibiotic use is in primary care, this knowledge is important in view of the global problem of antibiotic resistance.

Objectives. To assess antibiotic prescribing in primary care facilities in the Cape Town Metro District and compare it with current national guidelines, and to assess the reasons why prescriptions were not adherent to guidelines.

Methods. A retrospective medical record review was performed in April/May 2016. Records of all patients seen over 2 days in each of eight representative primary care facilities in the Cape Town Metro District were reviewed. The treatment of any patient who raised a new complaint on either of those days was recorded. Prophylactic antibiotic courses, tuberculosis treatment and patients with a non-infection diagnosis were excluded. Treatment was compared with the Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, 2014 edition.

Results. Of 654 records included, 68.7% indicated that an antibiotic had been prescribed. Overall guideline adherence was 45.1%. Adherence differed significantly between facilities and according to the physiological system being treated, whether the prescription was for an adult or paediatric patient, and the antibiotic prescribed. Healthcare professional type and patient gender had no significant effect on adherence. The main reasons for non-adherence were an undocumented diagnosis (30.5%), antibiotic not required (21.6%), incorrect dose (12.9%), incorrect drug (11.5%), and incorrect duration of therapy (9.5%).

Conclusions. This study demonstrates poor adherence to guidelines. Irrational use of antibiotics is associated with increased antibiotic resistance. There is an urgent need to improve antibiotic prescribing practice in primary care in the Cape Town Metro District.


Authors' affiliations

J Gasson, Improving Global Health Fellow, Health Impact Assessment, Western Cape Department of Health, South Africa; NHS Thames Valley and Wessex Leadership Academy, UK; THET/UK Aid in association with Health Education England, UK

M Blockman, Department of Internal Medicine, Division of Clinical Pharmacology, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa

B Willems, Division of Health Systems and Public Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

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Antibiotics; Antibiotic stewardship; Antibiotic guidelines; Prescription; Cape Town; South Africa; Public health

Cite this article

South African Medical Journal 2018;108(4):304-310. DOI:10.7196/SAMJ.2018.v108i4.12564

Article History

Date submitted: 2018-03-28
Date published: 2018-03-28

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