preprint · medRxiv
An analysis of prescribing records at the Jakaya Kikwete Cardiac Institute in Tanzania between 2016 and 2022 assessed antibiotic use among 11,656 cardiovascular inpatients. Over half of these patients, comprising 56.7 percent, received at least one systemic antibiotic, resulting in an overall consumption rate of 29.88 Defined Daily Doses per 100 bed-days. Injectable drugs accounted for over 55 percent of total use. Carbapenems were the most widely used class, with meropenem alone representing 45.6 percent of all antibiotic consumption. Evaluated against the World Health Organisation Access, Watch, Reserve system, Reserve category agents made up 46.4 percent of use, Watch agents comprised 31.3 percent, and Access agents accounted for 21.1 percent. Predictive modelling projects that antibiotic usage at the facility will continue to rise through 2026, indicating an urgent requirement for stricter hospital antimicrobial stewardship.
The disproportionate reliance on last-resort Reserve antibiotics in specialised inpatient care accelerates the risk of antimicrobial resistance. Monitoring these prescribing patterns provides essential baseline evidence for hospital administrators and clinical leaders seeking to protect critical medicines, design targeted prescribing interventions, and curb the emergence of drug-resistant pathogens in tertiary healthcare facilities.
The findings could inform the development and deployment of hospital antimicrobial stewardship programmes, clinical decision support software, and audit tools designed for tertiary cardiac centres. Healthcare providers and hospital administrators can apply these baseline patterns immediately to implement prescription monitoring, intravenous-to-oral switch protocols, and stricter drug access policies.
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Abstract Objective To analyse trends in antibiotic use among cardiovascular inpatients at the Jakaya Kikwete Cardiac Institute (JKCI), Tanzania, from 2016 to 2022, using the World Health Organisation (WHO) Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology. Design Retrospective longitudinal study. Setting Jakaya Kikwete Cardiac Institute, a 150-bed national referral and teaching hospital in Dar es Salaam, Tanzania. Patients 11,656 cardiovascular inpatients; 6,612 (56.7%) received at least one systemic antibiotic. Methods Prescription data (250,591 total; 30,885 antibiotic-related) were extracted from the JKCI MedPro dispensing system. Antibiotic use was expressed in Defined Daily Doses per 100 bed-days (DDD/100). Analyses were conducted using Microsoft Excel, SPSS version 26, and time-series forecasting with AutoRegressive Integrated Moving Average (ARIMA) modelling in R. Results Overall, antibiotic use was 29.88 DDD/100 bed-days. Injections accounted for more than 55% of use. At the ATC Class 4 level, carbapenems (J01DH) dominated (45.6%), followed by third-generation cephalosporins (17.0%) and extended-spectrum penicillins (14.6%). At the molecular level, meropenem contributed 45.6%, with amoxicillin and ceftriaxone also being prominent; the top 11 antibiotics comprised more than 90% of total use (Drug Utilisation 90% [DU90%]). By WHO Access, Watch, Reserve (AWaRe) classification, Reserve agents contributed 46.4% of use, followed by Watch (31.3%) and Access (21.1%). ARIMA (1,1,0) modelling forecasts a continued upward trend through 2026. Conclusions Antibiotic use among cardiovascular inpatients at JKCI is high, with heavy reliance on broad-spectrum and Reserve agents. Strengthened antimicrobial stewardship measures, such as intravenous-to-oral switch protocols, DU90 audits, and stricter control of Reserve antibiotic prescribing, are urgently needed to mitigate antimicrobial resistance risks.
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DOI: 10.1101/2025.09.24.25336595
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