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Table 1 Characteristics of studies on in-patients’ antimicrobial prescriptions

From: A systematic review of in-patients’ antimicrobial prescriptions and status of antimicrobial stewardship programmes in Nigerian hospitals

References

Study design

Major findings

Strengths

Limitations

Umeokonkwo et al. [15]

Cross-sectional

Less utilisation of available antimicrobial guidelines

High prevalence of antimicrobial prescribing

Sample size was determined and justified

Single centre

Abubakar, [17]

Cross-sectional

High prevalence of antimicrobial use

Broad spectrum antimicrobials were most frequently used

Prolonged surgical prophylaxis was observed

Study included both secondary and tertiary hospitals

Case files were reviewed for actual antimicrobial prescriptions

Justifiable sample size

Antimicrobial exposure was assessed once, and so may not be representative of routine use in the hospitals

Fawotade et al. [23]

Cross-sectional

Broad spectrum antimicrobials were most commonly prescribed

Non-existent compliance to guidelines was observed

Study included all the in-patients in all the wards

Antimicrobial prescriptions was assessed once

Kpokiri et al. [24]

Retrospective and cross-sectional (mixed method)

Broad spectrum antimicrobials were most commonly used

Relevant microbiological tests showed no evidence of need for some of the prescriptions

Low observance of Nigeria standard treatment guideline

Included secondary and tertiary healthcare facilities

Potential self-reporting bias

Oshikoya et al. [26]

Retrospective

Broad spectrum antimicrobials were most commonly prescribed

Poor compliance with international SAP guidelines

Under-dosing of most antimicrobials

Well defined study objectives

Uniform inclusion and exclusion criteria for study population

Single centre

Ogunleye et al. [11]

Cross-sectional

Antimicrobial prescriptions was commonly based on clinical judgment

Good sample size effect

Potential self-reporting bias

Exposure was assessed once

Abubakar et al. [14]

Cross-sectional

Observed redundant antimicrobial prescriptions

Broad spectrum antimicrobials was mostly used

Clearly defined and valid outcome measures

Lack of randomisation

Incomplete surveillance for surgical infections among patients

Primary and secondary hospitals were excluded, limiting generalisation

Roberts et al. [10]

Retrospective

Unnecessary antimicrobial use in some patients

Poor practice of relevant laboratory tests prior prescription

Few prescribers complied with departmental guidelines

Well defined objectives and reliable outcome measures

Single centre which limits generalisation

Efunshile et al. [9]

Cross-sectional

High prevalence of antibiotics use

Antibiotics were prescribed without apparent medical indications

Relevant microbial tests were performed during the study to determine the relevance of the prescribed antibiotics

Study included multi-centre

Follow-up of patients was performed after hospital discharge

Non-randomisation

Purposive sampling

Oyemolade et al. [28]

Retrospective

Unnecessary antimicrobial therapy was reported

Broad spectrum antimicrobials were mostly used

Clearly stated study objectives

Good sample size effect

Study was conducted in a single-centre, limiting generalisation of findings

Study did not also include outcome measures

Illiyasu et al. [29]

Retrospective

Unnecessary antibiotic therapy was reported

Frequent use of broad spectrum antibiotics was also seen

Clear study objectives, clearly specified study population

Single centre

Ekuma et al. [16]

Retrospective

High prevalence of antimicrobial prescriptions

Non-use of biomarkers to guide antimicrobial prescriptions

Clearly specified study population

Sample size was specified

Single centre