Rational use of medicines, particularly antimicrobials, is critical for reducing antimicrobial resistance. In 2021, a study conducted at the outpatient department (OPD) of a district hospital in Ghana, identified high antibiotic prescribing and suboptimal adherence to World Health Organization (WHO) prescribing indicators. Based on those findings, antimicrobial stewardship (AMS) intervention was extended to the OPD. This before-and-after study was used to compare WHO prescribing indicators and patterns of antibiotic use, using WHO AWaRe (Access, Watch and Reserve) categorisation of the years 2021 and 2023. A total of 65,157 patients visited the OPD in 2023 with 171,517 patient encounters and 247,313 prescriptions. Encounters resulting in antibiotic prescriptions halved from 36% to 18%. The average number of medicines prescribed per encounter reduced from three to two. Prescriptions using generic names increased from 76% to 80% and injection use reduced from 7% to 6%. However, prescriptions from the Ghana essential medicines list reduced from 90 % to 79%. Access antibiotics use remained unchanged while Watch and Reserve categories increased by 5% and 2% respectively. The AMS interventions potentially improved three of five WHO indicators. Continued efforts are needed to achieve complete compliance to all indicators and in-crease Access antibiotic use to above 70%.

Rational use of medicines, particularly antimicrobials, is critical for reducing antimicrobial resistance. In 2021, a study conducted at the outpatient department (OPD) of a district hospital in Ghana, identified high antibiotic prescribing and suboptimal adherence to World Health Organization (WHO) prescribing indicators. Based on those findings, antimicrobial stewardship (AMS) intervention was extended to the OPD. This before-and-after study was used to compare WHO prescribing indicators and patterns of antibiotic use, using WHO AWaRe (Access, Watch and Reserve) categorization of the years 2021 and 2023. A total of 65,157 patients visited the OPD in 2023 with 171,517 patient encounters and 247,313 prescriptions. Encounters resulting in antibiotic prescriptions halved from 36% to 18%. The average number of medicines prescribed per encounter reduced from three to two. Prescriptions using generic names increased from 76% to 80% and injection use reduced from 7% to 6%. However, prescriptions from the Ghana essential medicines list reduced from 90% to 79%. Access antibiotics use remained unchanged while Watch and Reserve categories increased by 5% and 2%, respectively. The AMS interventions potentially improved three of five WHO indicators. Continued efforts are needed to achieve complete compliance with all indicators and increase access antibiotic use to above 70%.

Commonwealth Partnerships for Antimicrobial Stewardship (AMS) uses a health partnership model to establish AMS in Commonwealth countries. The University Hospital of Kwame Nkrumah University of Science and Technology in partnership with Ulster University, in Northern Ireland undertook an AMS project from November 2021 to May 2022. We report on the implementation and its effect on antibiotic use and infections management at the University Hospital. The Global-Point Prevalence Survey (PPS) protocol was used to assess antibiotics use at the hospital at the beginning, midpoint and end of the project. Feedback on each PPS was given to staff to inform behaviour change and improve antibiotic prescribing. Antibiotic use reduced from 65% at baseline to 59.7% at the end of the project. The rate of health-associated infections also reduced from 17.5% at baseline to 6.5%. In addition, the use of antibiotics belonging to the WHO Access group at the hospital was 40% initially but increased to 50% at the project endpoint. Culture and antibiotic susceptibility requests increased from the beginning of the project from 111 total requests to 330 requests over 7 months. The AMS model implemented improved antibiotic use as well as requests for culture and susceptibility test which must be sustained.