Ciprofloxacin Sensitivity of <i>Staphylococcus</i>Strains Isolated at the Sylvanus Olympio University Hospital, Togo

Background: Staphylococcal infections are managed by hygiene measures and usage of antibiotics. The first-line treatment refers to beta-lactamins. However, the emergence of beta-lactamin resistant staphylococcal strains has been reported, as demonstrated by a study conducted in Lomé University Teaching Hospital, Bacteriology Laboratory (2001) on 742 Staphylococcus aureus strains which revealed 67.00% of them where methicillin resistant. In this setting of emergent methicillin-resistant strains, the second-line treatments are prescribed by clinicians without antibiograms. Fluoroquinolones are the first preference molecules used for second-line treatment because of their efficacy and affordability. We want to contribute to setting monitoring and alert-making tools for drug prescribers. Thus we conducted this study, aiming to determine the frequency of S. aureus and coagulase-negative staphylococci (CNS) strains isolation in different types of biologic samples, and to investigate the link between methicillin resistance and ciprofloxacin resistance. Methods: We conducted this study from January 2006 through Jun 2010. The Microbiology Laboratory Service collected and analyzed samples for diagnostic purpose from inpatients and outpatients consulted in the hospital. We collected and analyzed de-identified data on these patients to form laboratory records. Bacteriological analyses in which ciprofloxacin have not been tested were excluded. Results: Over the 1108 staphylococal strains isolated from various biological samples processed, 751 were Staphylococcus aureus and 357 were coagulase-negative staphylococci. The strains sensitivity profile is for all isolates. The majority of germs were S. aureus and 20% of them were ciprofloxacin-resistant. The probability of a patient who has an infection caused by S. aureus increases his stay in high-risk settings such as intensive care unit, surgical intervention, extended hospitalization, use of a catheter. The use of broad-spectrum antibiotics increases the risk of multidrug-resistant strains. Conclusion: This study highlights the recurring issue of over consumption of antibiotics in nowadays medical treatments. There is a need to raise awareness about the rational use of antibiotics in general and fluoroquinolones particularly.

Access to Antibiotics through Prescription and Non-Prescription Media in Private Pharmacies in Lomé, Togo

Objectives: The present study was conducted to describe and analyze antibiotic demands via prescription and non-prescription media received in private pharmacies in Lomé. Methods: A cross-sectional study was conducted in 26 private pharmacies in Lomé (Togo) from August to October 2013. The study was based on a survey conducted with a standardized questionnaire to collect data representing the daily activity of the pharmacies. Data on prescription documents, non-prescription media, patients’ and prescribers’ identification, and antibiotics requested were collected and analyzed. Key findings: During the study period, 596 antibiotic prescriptions were collected. Various prescription and non-prescription media permitted available antibiotic access in private pharmacies. Seventy-nine percent (79%) of the received orders contained one antibiotic. All categories of health care professionals were found among antibiotic prescribers. Prescribers were not identifiable in 40.2% of all prescription tools received for antibiotics demand. Forty-four percent (44%) of antibiotic orders were supported by a prescription. The study found that many people ordering antibiotic (61%) were not the direct users. Some elements of prescription compliance were mentioned at the rate of 82%, 44.7% and 59% (date, prescribers’ identity and qualification), 3/4 of the prescription material (patients’ identity and sex), more than 87% (accuracy of the dosage), 79.7% (oral route of administration) and less than 1/3 (duration of treatment). The results also indicated that Beta-lactams (41%), quinolones (17%), and 5-nitroimidazoles (15%) were the most prescribed classes of antibiotics. Conclusions: The study revealed that more than half of the antibiotics orders, received in pharmacies were non-compliant. This calls for an awareness of healthcare workers and populations on the rational use of antibiotics. Access to antibiotics should be further controlled (prescription dispensing), community should ban other media of obtaining antibiotics without a prescription and avoid particularly antimicrobial self-medication.