Antimicrobial Use in a Paediatric Hospital in Kenya: A Point Prevalence Survey to Inform Antimicrobial Stewardship

Joseph Mbuthia ^1* Nkatha Gitonga ² Winnie Akoth ^1* Susan Mutua ^1* Ndinda Kusu ^2* Tamara Hafner ^3* Mohan P Joshi ^3* Martha Embrey ^4*

• ¹ Gertrude's Children's Hospital, Nairobi, Kenya
• ² USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Nairobi, Kenya
• ³ USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, VA, United States
• ⁴ Global Health Systems Innovation, Management Sciences for Health, Arlington, VA, United States

A baseline point prevalence survey (PPS) was conducted at Gertrude's Children's Hospital (GCH), a private paediatric hospital in Kenya, to assess antimicrobial use (AMU) patterns, adherence to antimicrobial stewardship (AMS) protocols, and compliance with treatment guidelines. The survey aimed to provide insights into antimicrobial prescribing practices in a paediatric setting and address a critical gap in data from private healthcare facilities in Kenya. Methods: The PPS included all inpatients as of 13 May 2022, excluding those discharged on that date, day cases, and those prescribed topical antimicrobials. Data were collected using a tool adapted from the WHO's PPS standardized methodology, focusing on antimicrobial prescribing trends, compliance with GCH guidelines, and adherence to WHO's Access, Watch, and Reserve categorization. Results: The results showed that 61% of inpatients were on antimicrobials, with systemic antibacterials (J01) being the most prescribed, particularly third-generation cephalosporins, penicillin combinations, and imidazole derivatives. Ceftriaxone was the most commonly used antimicrobial, and the average number of antimicrobials prescribed per patient was 1.2. Prescribing practices showed a high use of Watch category antibiotics (51%) and a predominant use of the intravenous (IV) route (74%). Discussion: Only 50% of prescriptions complied with guidelines and microbiological findings; we identified significant areas for improvement, including the need for structured reviews of antimicrobial prescriptions, better alignment with AMS objectives, and enhanced training on treatment guidelines, diagnostic stewardship, and infection prevention and control. Conclusion: The survey concludes that the PPS provides valuable data to inform AMS interventions at GCH, recommending the development of policies for IV-to-oral switch criteria, enhancement of the health management system, establishment of antimicrobial ward rounds, and improved education on laboratory result interpretation and appropriate sample collection.