Appropriate use of ceftriaxone in sub-saharan Africa: A systematic review

Introduction: Ceftriaxone is the most frequently used antibiotic for the treatment of various bacterial infections in hospitalized and ambulatory patients. Despite this, inappropriate ceftriaxone use is common. Objective: The aim of this review is to assess the appropriate use of ceftriaxone in sub-Saharan African countries. Methods: A systematic search was done on PubMed, EMBASE, Cochrane Libraries and Google Scholar for papers published addressing the prescribing pattern and use of ceftriax-one in sub-Saharan Africa. The findings were reported in medians and quartiles. Results: A total of 15 articles met the inclusion criteria. Pneumonia and sepsis were the most frequently diagnosed infections in the included studies. The overall median prevalence of appropriate ceftriaxone use is 39.2% (IQR: 29.9–60.9), showing that most of the included studies reported a higher prevalence of inappropriate ceftriaxone use. Although there are a higher number of patients with inappropriate use of ceftriaxone, a relatively higher number of patients got appropriate daily dose (79.8%, IQR: 45.7–89.4) of ceftriaxone than appropriate duration of ceftriaxone (55%, IQR: 52.2–80). Conclusion: The review revealed that three in five patients with ceftriaxone got inappropriate ceftriaxone’s dose, frequency or duration. A relatively higher number of patients got appropriate daily dose of ceftriaxone. On the other hand, approximately more than half of the patients got inappropriate duration, too short or too long, of ceftriaxone. Hence, prescribers are recommended to adhere to their country-specific treatment guideline. Moreover, it is highly recommended to either commence or strengthen antimicrobial stewardship program effectively in their healthcare settings.