The increase and global dissemination of antibiotic resistance are limiting the use of antibiotics to prevent and treat infections. Implementing antibiotic stewardship programs (ASPs) based on local data on prescribing profiles is a valuable strategy to reduce the burden of antibiotic resistance. This study, conducted at Luang Prabang Provincial Hospital, Lao PDR, revealed a significant prevalence of antibiotic use and very low adherence to established guidelines, underscoring the urgent need for comprehensive strategies to optimize antibiotic use in hospitals.
The results showed widespread use of antibiotics, particularly broad-spectrum antibiotics, with poor adherence to guidelines. This highlights the need to raise awareness and support the implementation of ASPs in hospitals. In addition, the data collected will provide an important baseline for monitoring antibiotic prescribing patterns and evaluating the effectiveness of ASP interventions over time in Lao PDR.
To ensure the success of these programs, it is critical to allocate resources to develop evidence-based antibiotic guidelines tailored to local resistance patterns. There should also be a focus on improving documentation of antibiotic prescriptions, increasing the use of microbiological testing, and improving laboratory services. Finally, it is essential to continuously evaluate the implementation and impact of ASP interventions to ensure their long-term effectiveness.
To address these challenges and improve antibiotic use, a clearer understanding of current prescribing practices is essential. A point prevalence survey was conducted among hospitalized patients on May 25, 2023, in which 58.8% (60 of 102) received antibiotic treatment. Combination therapy was common, with 55% of these patients receiving more than one antibiotic. The highest antibiotic use was found in the surgical ward (93%) and in the pediatric ward (67%).
Antibiotics were prescribed primarily for community-acquired infections (47%), surgical prophylaxis (26%), and hospital-acquired infections (13%). The most used antibiotics were ceftriaxone (34.6%), metronidazole (17.3%), ampicillin and gentamicin (both 7.7%). However, laboratory diagnostics were rarely used, with only two samples tested, one of which showed Escherichia coli resistant to beta-lactam antibiotics.
According to the WHO Access, Watch and Reserve classification, 52.9% of antibiotics were in the Access category, 47.1% in the Watch category and none in the Reserve category. Only 14.9% of prescriptions were fully compliant with current guidelines, reflecting poor compliance.
The study concludes that antibiotic use in the hospital is high, but adherence to guidelines is low, underscoring the need for strategies to improve antibiotic stewardship, enhance diagnostic tools, and promote research into the factors that contribute to antibiotic misuse.
About the project
The Fleming Fund’s program of national, regional and fellowship grants managed by Mott MacDonald, aims to improve member countries’ capacity to diagnose antimicrobial-resistant bacteria, generate data and strengthen surveillance to inform policy and practice at national and international levels. In 2019, Mot MacDonald launched a “national grant” call for proposals to strengthen the antimicrobial resistance surveillance system in Laos.
The Mérieux Foundation has been selected as the “lead national grantee” to implement activities related to this grant in line with the Fleming Fund’s strategies and initiatives in Lao PDR.
In the next phase of the Fleming Fund (phase II), the Mérieux Foundation will continue to support Lao PDR’s AMR surveillance system, focusing on the production, analysis and sharing of quality human health data. This will enable the program to develop a sustainable long-term investment plan to combat AMR by better understanding its prevalence and epidemiological trends at country level.