Antibiotic Prescribing Patterns at Six Hospitals in Lesotho
(2011; 40 pages)

Ntšekhe M., N. Hoohlo-Khotle, M. Tlali, and D. Tjipura. 2011. Antibiotic Prescribing Patterns at Six Hospitals in Lesotho. Submitted to the US Agency for International Development by the Strengthening Pharmaceutical Systems (SPS) Program. Arlington, VA: Management Sciences for Health.


The 1985 World Health Organization (WHO) conference on rational medicine use (RMU) marked the beginning of efforts to improve the use of medicines, especially in developing countries. The First International Conference on Improving Use of Medicines, held in Thailand in 1997, identified the need for a set of indicators and appropriate methodology to assess the use of medicines, particularly antimicrobials, in hospitals. The Second International Conference on Improving Use of Medicines confirmed the need for medicine use indicators to measure trends in pharmaceutical management, prescribing, and dispensing in the public and private sectors. The detection of problems with the use of antimicrobial medicines in hospitals is the first step in evaluating the underlying causes and taking remedial action (SPS, 2008).

The Ministry of Health and Social Welfare (MOHSW) has been actively assessing the state of pharmaceutical management and use of medicines since 2007, by conducting the Medicines Access Surveys (2007 and 2009). Because the management and use of antimicrobials has clinical, economic, and environmental implications and because, in many countries, antimicrobials are the most frequently prescribed therapeutic agents accounting for 30–50% of prescriptions for medicines, MOHSW decided to carry out a more focused assessment on the use and management of antibiotics at six hospitals in Lesotho.

The study sought to answer a number of questions relating to antibiotic prescribing patterns at these six hospitals. Quantitative data was collected, counted numerically, and used to identify the prescribing patterns within the six hospitals. The qualitative data was used to measure the quality of prescribing patterns and to determine the reasons behind the identified prescribing patterns. Three core, one patient, and three complimentary medicine use indicators from the WHO Drug Use Indicators (Outpatient Facilities) list were assessed.

Sample selection was convenient, focusing on hospitals that were already supported by the Strengthening Pharmaceutical Systems (SPS) Program of MOHSW. During sampling, we considered supporting hospital pharmaco-therapeutic committees (HPTCs) and data management with RxSolution, an electronic pharmaceutical data management tool developed by Management Sciences for Health. Data collectors were trained and the data collection tools were piloted at the main referral hospital in Lesotho, Queen Elizabeth (QE) II Hospital. The results indicate that polypharmacy may be a problem in Lesotho in outpatient settings because the average number of medicines prescribed per encounter is 3.8; of these, 37.6% are antibiotics. Adherence to STGs stands at 42.8%, and 79% of the prescribed medicines were from the EML. Generic prescribing is a serious gap, with only 35.6% of the prescriptions issued being generic. Supply chain management, however, is a strong area of the system, with over 89% of the prescribed medicines being available and actually dispensed.

The use of tools, structures, and systems, such as STGs, HPTCs, and facility-specific RMU programs, needs to be strengthened to improve use of antibiotics at hospitals.

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