preprint · medRxiv
Outpatient settings often contribute to avoidable antibiotic exposure, yet patient-level dispensing data in Tanzania remain scarce as most metrics rely on import or sales figures. A five-year retrospective study evaluated systemic antibiotic consumption among outpatients at the Jakaya Kikwete Cardiac Institute in Dar es Salaam between July 2017 and June 2022. Overall, 11,586 outpatients received at least one systemic antibiotic. Across the study period, outpatient antibiotic use remained low and stable, between 0.27 and 0.38 defined daily doses per 100 outpatients per day. Beta-lactam and penicillin drugs dominated consumption. According to the World Health Organization classification, Access antibiotics made up 48.5 percent of cumulative exposure, Watch antibiotics represented 45.5 percent, and Reserve antibiotics accounted for 5.9 percent. The Access proportion did not meet the global 60 percent target. Time-series analysis showed a modest upward trend peaking in early 2021, alongside recurring seasonal variations.
Tracking actual outpatient antibiotic dispensing helps hospitals detect inappropriate drug use and curb antimicrobial resistance. Cardiopulmonary symptoms often prompt precautionary antibiotic prescriptions. Demonstrating that dispensing records can measure patient-level consumption allows healthcare facilities to monitor prescribing habits accurately and benchmark their practices against international standards.
The findings support the development and integration of dispensing-based surveillance tools into routine hospital antimicrobial stewardship dashboards. Potential users include hospital administrators, clinical pharmacists, and healthcare IT developers seeking to implement automated prescribing monitors. While the methodology has been applied and tested retrospectively within a cardiac tertiary hospital, software tools for real-time surveillance would require further operational development and integration into hospital information systems.
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Abstract Background Outpatient encounters are significant contributors to avoidable antibiotic exposure. However, the dispensing-based outpatient consumption data for Tanzania are limited. Most national estimates rely on import or sales data that do not reflect patient-level use. Cardiovascular clinics are particularly relevant because cardiopulmonary symptom overlap can lead to precautionary prescribing. Methods We conducted a retrospective dispensing-based utilization analysis of cardiovascular outpatients at the Jakaya Kikwete Cardiac Institute (JKCI) in Dar es Salaam, Tanzania, from July 2017 to June 2022. Systemic antibacterial agents were mapped to the World Health Organization anatomical therapeutic chemical/defined daily dose (WHO ATC/DDD) and expressed as defined daily doses per 100 outpatients per day. Consumption patterns were summarized by fiscal year, molecule, ATC level 3, and WHO Access/Watch/Reserve (AWaRe) category. Monthly consumption was decomposed to evaluate trends and seasonality. Results A total of 11,586 outpatients received at least one systemic antibiotic during the study period. Annual outpatient antibiotic utilization remained low and stable, ranging from approximately 0.27 to 0.38 DDD per 100 outpatients per day across fiscal years, with a cumulative total of 1.68 DDD per 100 outpatients per day across the five years. Consumption was dominated by beta-lactam/penicillin antibiotics, with Access antibiotics accounting for 48.5% of cumulative exposure, followed by Watch antibiotics (45.5%) and minimal Reserve use (5.9%). However, the Access proportion was below the WHO Access-60 benchmark for optimal outpatient use. Time-series decomposition revealed a modest upward trend, peaking in early 2021, accompanied by a recurring seasonal pattern of monthly use. Conclusion Outpatient antibiotic utilization at JKCI was quantitatively low, yet showed persistent exposure dominated by Access antibiotics. Dispensing-based outpatient surveillance is feasible and should be integrated into routine stewardship dashboards to target avoidable outpatient antibiotic use.
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DOI: 10.1101/2025.11.18.25340496
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