ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2020
Sustained Reduction in Third-generation Cephalosporin Usage in Adult Inpatients Following Introduction of an Antimicrobial Stewardship Program in a Large, Urban Hospital in Malawi.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
32 citing papers in PubMed, 4 syntheses or guidelines pooled it, 40 citations in OpenAlex.
- Assessing the implementation determinants of antimicrobial stewardship programmes in sub-Saharan Africa through the complexity lens. A CFIR-guided systematic review.Frontiers in microbiology · 2025Pooled it
- Protocols, policies and practices for antimicrobial stewardship in hospitalized patients in least-developed and low-income countries: a systematic review.Antimicrobial resistance and infection control · 2023Pooled it
- Barriers and facilitators of implementing interventions to improve appropriate antibiotic use in low- and middle-income countries: a systematic review based on the Consolidated Framework for Implementation Research.Implementation science : IS · 2022Pooled it
- Pooled it
- Antibiotic overuse as a modifiable early-life risk factor for non-communicable diseases in sub-Saharan Africa.Global health action · 2026Article
- Addressing the silent epidemic of antimicrobial resistance in the African region: a scoping review of evidence gaps and research considerations.BMJ public health · 2026Article
- Patterns of antibiotic use among adult patients across seven hospitals in Malawi: opportunities and challenges for antimicrobial stewardship programmes.Journal of pharmaceutical policy and practice · 2026Article
- Longitudinal analysis of antimicrobial consumption and economic outcomes of surgical prophylaxis stewardship in a wartime Ukrainian maternity hospital.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- Economic costing methodologies for drug-resistant bacterial infections in humans in low-and middle-income countries: a systematic review.Health economics review · 2025Review
- Antimicrobial Stewardship Impact on Antibiotic Use in Three Tertiary Hospitals in Zambia: A Comparative Point Prevalence Survey.Antibiotics (Basel, Switzerland) · 2025Article
- A baseline assessment of antimicrobial stewardship core element implementation in selected public hospitals in Malawi: findings from the 2023 National Program Audit.Frontiers in public health · 2025Article
- Barriers, facilitators, perceptions and impact of interventions in implementing antimicrobial stewardship programs in hospitals of low-middle and middle countries: a scoping review.Antimicrobial resistance and infection control · 2024Article
- Methicillin-resistantQatar medical journal · 2024Article
- Asymptomatic gastrointestinal carriage of multidrug-resistant carbapenemase-producing Enterobacteriaceae among children under five years in a Kenyan hospital.IJID regions · 2023Article
- Antimicrobial resistance control activities at a tertiary hospital in a low-resource setting: an example of Queen Elizabeth Central Hospital in Malawi.Frontiers in antibiotics · 2023Article
- Genomic analysis of extended-spectrum beta-lactamase (ESBL) producingMicrobial genomics · 2023Article
- Characteristics of the clinical pharmacists' interventions at the main general tertiary care hospital in Qatar.Qatar medical journal · 2023Article
- Current Antibiotic Use Among Hospitals in the sub-Saharan Africa Region; Findings and Implications.Infection and drug resistance · 2023Review
- Point Prevalence Survey of Antimicrobial Use during the COVID-19 Pandemic among Different Hospitals in Pakistan: Findings and Implications.Antibiotics (Basel, Switzerland) · 2022Article
- Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future.Antibiotics (Basel, Switzerland) · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
18 authors at 11 institutions in 4 countries.
Funding
Abstract
backgroundThird-generation cephalosporins (3GC) remain the first-choice empiric antibiotic for severe infection in many sub-Saharan African hospitals. In Malawi, the limited availability of alternatives means that strategies to prevent the spread of 3GC resistance are imperative; however, suitable approaches to antimicrobial stewardship (AMS) in low-income settings are not well studied.
methodsWe introduced an AMS intervention to Queen Elizabeth Central Hospital in Blantyre. The intervention consisted of a prescribing application for smartphones and regular point-prevalence surveys with prescriber feedback. We evaluate the effects of the intervention on 3GC usage and on the cost of providing antibiotics. Using a thematic analysis of semi-structured interviews and participant observations, we additionally evaluate the acceptability of the stewardship program.
resultsThe proportion of antibiotic prescriptions for a 3GC reduced from 193/241 (80.1%) to 177/330 (53.6%; percentage decrease, 26.5%; 95% confidence interval, 18.7-34.1) with no change in the case-fatality rate. The cost analysis estimated an annual savings of US$15 000. Qualitative research revealed trust in the guideline and found that its accessibility through smartphones helpful to guide clinical decisions. Operational health-system barriers and hierarchal clinical relationships lead to continued reliance on 3GC.
conclusionsWe report the successful introduction of an antimicrobial stewardship approach in Malawi. By focusing on pragmatic interventions and simple aims, we demonstrate the feasibility, acceptability, and cost savings of a stewardship program where resources are limited. In doing so, we provide a suitable starting point for expansions of AMS interventions in this and other low-income settings.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.