Medication Related Problems Among Patients On Antibiotic Therapy In The Medical Wards At Kenyatta National Hospital-- University Of Nairobi

Abstract

Background: Medication related problems (MRPs), are patient drug use outcomes that affect the achievement of optimal benefit of drug therapy. Errors in drug prescribing, administration, monitoring or dispensing, antibiotic unavailability, non-adherence by the patient and idiosyncratic response to antibiotic use all contribute to MRP occurrence. Objectives: This study aimed to investigate the prevalence of MRPs among patients on antibiotics in the medical wards at Kenyatta National Hospital (KNH). Methodology: Cross sectional study design was adopted for this study. Ninety four participants were systematically selected from patients admitted in the medical wards. The prevalence of the MRPs as classified by Hepler and Strand (1990) were then determined through participant interview and medication record review. Continuous normally distributed variables were presented as means and standard deviations, while median and interquartile range were used to describe continuous non-normally distributed variables. Categorical variables, at 95% level of significance, were presented as frequencies and percent proportions Stata 13 software was used to infer association between the MRPs and variables. Chi-Square, Fischer’s exact test, Wilcoxon rank sum test, Shapiro and Wilks test for normality were used, where appropriate, to derive the inferences. Results: Drug-drug interactions (13.8%), improper drug selection (13.8%) and over dosage (12.8%) were the most prevalent MRPs due to antibiotic use. The bivariate analysis to assess the factors associated with the MRPs found out that marital status (p=0.025), lower estimated glomerular filtration rate, eGFR, (p=0.016), ceftriaxone (p=0.015), carbapenems (p=0.033) and ceftazidime use (p=0.001) were significantly associated with the occurrence of MRPs. On multivariate logistic regression analysis of these variables to assess their joint effect, the only variables which explained the prevalence of the MRPs were the use of ceftazidime (OR: 5.62 (95% CI: 1.34, 23.5) and lower eGFR (OR: 5.22 (95% CI: 1.18, 23.0). Conclusion: MRPs regarding use of antibiotics are prevalent despite their preventability. To forestall the rising bacterial resistance, control unnecessary healthcare burden and decrease morbidity and mortality due to antibiotic use, there is a need for concerted effort from medical institutions and health care personnel to promote rational antibiotic use and prevent MRPs that hamper achievement of quality health outcomes for the patients