Point prevalence study of antimicrobial use among hospitals across Botswana; findings and implications

Expert Rev Anti Infect Ther. 2019 Jul;17(7):535-546. doi: 10.1080/14787210.2019.1629288. Epub 2019 Jul 1.


Objective: There is an urgent need to undertake Point Prevalence Surveys (PPS) across Africa to document antimicrobial utilisation rates given high rates of infectious diseases and growing resistance rates. This is the case in Botswana along with high empiric use and extended prophylaxis to prevent surgical site infections (SSIs) Method: PPS was conducted among all hospital sectors in Botswana using forms based on Global and European PPS studies adapted for Botswana, including rates of HIV, TB, malaria, and malnutrition. Quantitative study to assess the capacity to promote appropriate antibiotic prescribing. Results: 711 patients were enrolled with high antimicrobial use (70.6%) reflecting an appreciable number transferred from other hospitals (42.9%), high HIV rates (40.04% among those with known HIV) and TB (25.4%), and high use of catheters. Most infections were community acquired (61.7%). Cefotaxime and metronidazole were the most prescribed in public hospitals with ceftriaxone the most prescribed antimicrobial in private hospitals. Concerns with missed antibiotic doses (1.96 per patient), high empiric use, extended use to prevent SSIs, high use of IV antibiotics, and variable infrastructures in hospitals to improve future antibiotic use. Conclusion: High antibiotic use reflects high rates of infectious diseases observed in Botswana. A number of concerns have been identified, which are being addressed.

Keywords: Antibiotics; Botswana; antimicrobial resistance; antimicrobial stewardship programs; antimicrobial utilization; drugs and therapeutic committees; hospitals; point prevalence studies.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-Bacterial Agents / administration & dosage*
  • Botswana / epidemiology
  • Child
  • Child, Preschool
  • Community-Acquired Infections / drug therapy
  • Community-Acquired Infections / epidemiology
  • Cross-Sectional Studies
  • Drug Resistance, Microbial
  • Female
  • HIV Infections / epidemiology
  • Hospitals, Private / statistics & numerical data
  • Hospitals, Public / statistics & numerical data
  • Humans
  • Inappropriate Prescribing / prevention & control
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Prevalence
  • Surgical Wound Infection / prevention & control*
  • Tuberculosis / epidemiology
  • Young Adult


  • Anti-Bacterial Agents