Paa Kwesi Fynn Hope

Empirical antibiotic treatment is common in acute conjunctivitis despite most cases being non-infectious or viral infections. Operational research (OR) at an eye hospital in Ghana (January–December 2021) identified appropriate antibiotic prescription in 71% of cases. Research dissemination and the sensitisation of key stakeholders followed, including communication of findings and implications to hospital prescribers. We conducted this OR covering January–December 2024 to test the hypothesis that the appropriateness of antibiotic prescriptions will improve, and to investigate the types of antibiotics prescribed and their AWaRe classification. There were 220 acute conjunctivitis cases in 2024, comparable to 2021 (201 cases). Antibiotics were prescribed in 67% of cases in 2024 and 55% in 2021 (aOR 2.51, 95% CI: 1.51–4.19, p < 0.001). Antibiotic prescription appropriateness was higher in 2024 than in 2021: 87% and 71%, respectively (95% CI for change: 5.99–25.99%, p = 0.001). In 2021, only ACCESS and WATCH antibiotics were prescribed. However, 15% of prescriptions in 2024 were RESERVE antibiotics, and multiple antibiotic prescriptions increased from 10% to 22%. This research demonstrates that regular operational research and interventions have the potential to improve antibiotic prescribing in ophthalmic practice in Ghana. It is imperative that the recommendations made by the initial researchers are fully implemented to protect the efficacy of available antibiotics.

Empirical antibiotic treatment is common in acute conjunctivitis despite most cases being non-infectious or viral infections. Operational research (OR) at an Eye Hospital in Ghana (Jan-Dec 2021) identified appropriate antibiotic prescription in 71% of cases. A campaign of research dissemination and sensitisation of key stakeholders followed, which included communicating the findings and implications to prescribing staff at the hospital. We conducted further OR covering the period Jan-Dec 2024 to test the hypothesis that appropriateness of antibiotic prescriptions will improve, to investigate the types of antibiotics prescribed and to evaluate the appropriateness of non-prescription of antibiotics. We found antibiotic prescription appropriate in 87% of cases, a 16% improvement on the 2021 findings. In 91% of all cases, the use or non-use of antibiotics was assessed as appropriate. All antibiotics used in 2021 were in ACCESS and WATCH categories. However, 15% of 2024 prescriptions were RESERVE antibiotics. This could have been driven by stock outs of ACCESS or WATCH alternatives. This research has demonstrated the power of regular operational research and interventions to improve antibiotic prescribing in eye health in Ghana. It is imperative that the recommendations of the initial researchers are fully implemented, to protect the future efficacy of available antibiotics.

Most presentations of conjunctivitis are acute. Studies show that uncomplicated cases resolve within 14 days without medication. However, antibiotic prescription remains standard practice. With antimicrobial resistance becoming a public health concern, we undertook this study to assess antibiotic prescription patterns in managing acute conjunctivitis in an eye hospital in Ghana. We recorded 3708 conjunctivitis cases; 201 were entered as acute conjunctivitis in the electronic medical records (January to December 2021). Of these, 44% were males, 56% were females, 39% were under 5 years, 21% were children and adolescents (5–17 years) and 40% were adults (≥18 years). A total of 111 (55.2%) patients received antibiotics, of which 71.2% were appropriately prescribed. The use of antibiotics was more frequent in children under 17 years compared to adults (p < 0.0001). Of the prescribed antibiotics, 44% belonged to the AWaRe “Access” category (Gentamycin, Tetracycline ointment), while 56% received antibiotics in the “Watch” category (Ciprofloxacin, Tobramycin). Although most of the antibiotic prescribing were appropriate, the preponderance of use of the Watch category warrants stewardship to encompass topical antibiotics. The rational use of topical antibiotics in managing acute conjunctivitis will help prevent antimicrobial resistance, ensure effective health care delivery, and contain costs for patients and the health system.