Community-Based Surveillance of Antimicrobial Use and ...

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6. Durban, South Africa6.2.2.2 Prescription examinationData were collected from each facility for one week every month by trained research staff.They used original prescriptions for collecting data from pharmacies, which were fullycomputerized. In the clinics, the data were extracted from daily statistical return sheets, or“tick registers”. In dispensing practitioner settings the data were extracted from noncomputerizedclinical records. All prescriptions or patient records for the week prior to thevisit were examined, and details for those containing ABM captured on a pre‐designed form.When it became apparent that the required 30 ABM‐containing prescriptions per monthwere not being attained in each pharmacy, the field workers returned to examineprescriptions for another week in each month. The identity of the ABM(s), dose and durationwere recorded and used to calculate the DDD per 100 patients. For both this and thedetermination of the percentage of prescriptions containing at least one ABM, thedenominator was the total number of prescriptions or records examined. The same facilitieswere used through out the study period. ABMs from the imidazole groups were included.6.2.3 Data managementData were captured and analysed using Microsoft Excel 2003.6.3 FindingsData from a total of 16 months, from October 2002 to January 2004, was available from thispilot site.6.3.1 AMR in potential respiratory pathogensIn all, of 311 H. influenzae, 184 S. pneumoniae and 30 Moraxella spp. were isolated and testedfor susceptibility by MIC determination during the study period of 16 months. The overallresistance pattern is shown in Table 6.1 and Figure 6.1. As was noted before, because ofdeviations from the relevant NCCLS/CLSI guidelines, susceptibility to penicillin andfluoroquinolones among S. pneumoniae isolates could not be reported. It was notable thatnearly 84% of the H. influenzae isolates tested were reported to be resistant to ampicillin.Table 6.1: Resistance pattern of bacteria testedS. pneumoniae (n=184) H. influenzae (n= 311) Moraxella spp.(n=30)Numberresistant%resistantNumberresistant%resistantNumberresistant%resistantAmpicillin 260 83.6 30 100.0Erythromycin 35 19 9 2.9 9 30.4Chloramphenicol 3 1.6 8 2.6 1 3.4Cotrimoxazole 103 55.6 150 48.2 30 100.0Ciprofloxacin 1 0.3 10 33.4Rifampicin 9 4.9 15 4.8 2 6.771
Community-based surveillance of antimicrobial useand resistance in resource-constrained settingsFig. 6.1: Percentage of AMR in H. influenzae and S. pneumoniae betweenOctober 2002 to March 20049080% resistance706050403020100H.influenzaeS.pneumoniaeAmpi Erythro Cotrim Chloro Rifam Cipro6.3.1.1 Trends in AMR over timeToo few isolates were obtained to allow for analysis on a monthly basis, but quarterly trendsfor resistance in H. influenzae and S. pneumoniae isolates over time did not show anydiscernible trends, as depicted in Figure 6.2..72
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WHO/EMP/MAR/2009.2Community-Based S
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CONTENTSProject members ...........
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8.4 Lessons learnt concerning imple
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Community-based surveillance of ant
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How this report is organizedHow thi
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Executive summaryExecutive summaryI
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Executive summaryAlthough ABM use a
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1. Background, aims and general met
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