{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T04:19:14Z","timestamp":1778732354128,"version":"3.51.4"},"reference-count":42,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T00:00:00Z","timestamp":1648425600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Inappropriate use of antibiotics during the COVID-19 pandemic has the potential to increase the burden of antimicrobial resistance. In this study, we report on the prevalence of antibiotic use and its associated factors among suspected and confirmed COVID-19 patients admitted to 35 health facilities in Sierra Leone from March 2020\u2013March 2021. This was a cross-sectional study using routinely collected patient data. Of 700 confirmed COVID-19 patients, 47% received antibiotics. The majority (73%) of the antibiotics belonged to the \u2019WATCH\u2019 group of antibiotics, which are highly toxic and prone to resistance. The most frequently prescribed antibiotics were azithromycin, ceftriaxone, amoxicillin, metronidazole, and amoxicillin-clavulanic acid. Antibiotic use was significantly higher in patients aged 25\u201334 years than in those with severe disease. Of 755 suspected COVID-19 patients, 61% received antibiotics, of which the majority (58%) belonged to the \u2018WATCH\u2019 category. The most frequently prescribed antibiotics were ceftriaxone, metronidazole, azithromycin, ciprofloxacin, and amoxycillin. The prevalence of antibiotic use among suspected and confirmed COVID-19 patients admitted to healthcare facilities in Sierra Leone was high and not in line with national and WHO case management guidelines. Training of health care providers, strengthening of antimicrobial stewardship programs, and microbiological laboratory capacity are urgently needed.<\/jats:p>","DOI":"10.3390\/ijerph19074005","type":"journal-article","created":{"date-parts":[[2022,3,29]],"date-time":"2022-03-29T21:44:52Z","timestamp":1648590292000},"page":"4005","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Antibiotic Use in Suspected and Confirmed COVID-19 Patients Admitted to Health Facilities in Sierra Leone in 2020\u20132021: Practice Does Not Follow Policy"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1454-4650","authenticated-orcid":false,"given":"Ibrahim Franklyn","family":"Kamara","sequence":"first","affiliation":[{"name":"World Health Organization, 21A-B Riverside, Off King Harman Road Freetown, Freetown 00232, Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1011-8531","authenticated-orcid":false,"given":"Ajay M. V.","family":"Kumar","sequence":"additional","affiliation":[{"name":"International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France"},{"name":"International Union Against Tuberculosis and Lung Disease, South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India"},{"name":"Yenepoya Medical College, Yenepoya (Deemed to be University), University Road, Deralakatte, Mangalore 575018, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6417-7273","authenticated-orcid":false,"given":"Anna","family":"Maruta","sequence":"additional","affiliation":[{"name":"World Health Organization, 21A-B Riverside, Off King Harman Road Freetown, Freetown 00232, Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3276-8949","authenticated-orcid":false,"given":"Bobson Derrick","family":"Fofanah","sequence":"additional","affiliation":[{"name":"World Health Organization, 21A-B Riverside, Off King Harman Road Freetown, Freetown 00232, Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles Kuria","family":"Njuguna","sequence":"additional","affiliation":[{"name":"World Health Organization, 21A-B Riverside, Off King Harman Road Freetown, Freetown 00232, Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven","family":"Shongwe","sequence":"additional","affiliation":[{"name":"World Health Organization, 21A-B Riverside, Off King Harman Road Freetown, Freetown 00232, Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9490-6537","authenticated-orcid":false,"given":"Francis","family":"Moses","sequence":"additional","affiliation":[{"name":"Ministry of Health and Sanitation, 4th Floor, Youyi Building, Brookfields, Freetown 00232, Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7287-4426","authenticated-orcid":false,"given":"Sia Morenike","family":"Tengbe","sequence":"additional","affiliation":[{"name":"Ministry of Health and Sanitation, 4th Floor, Youyi Building, Brookfields, Freetown 00232, Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0799-6907","authenticated-orcid":false,"given":"Joseph Sam","family":"Kanu","sequence":"additional","affiliation":[{"name":"National Disease Surveillance Program, Ministry of Health and Sanitation, Sierra Leone National Public Health Emergency Operations Centre, Cockerill, Wilkinson Road, Freetown 00232, Sierra Leone"},{"name":"Department of Community Health, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7639-0004","authenticated-orcid":false,"given":"Sulaiman","family":"Lakoh","sequence":"additional","affiliation":[{"name":"Ministry of Health and Sanitation, 4th Floor, Youyi Building, Brookfields, Freetown 00232, Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alie H. D.","family":"Mansaray","sequence":"additional","affiliation":[{"name":"Crops Division, Ministry of Agriculture and Forestry, Youyi Building, Brookfields, Freetown 00232, Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kalaiselvi","family":"Selvaraj","sequence":"additional","affiliation":[{"name":"All India Institute of Medicine Sciences, Nagpur 441108, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"Khogali","sequence":"additional","affiliation":[{"name":"Special Program for Research and Training in Tropical Diseases (TDR), World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2915-9328","authenticated-orcid":false,"given":"Rony","family":"Zachariah","sequence":"additional","affiliation":[{"name":"Special Program for Research and Training in Tropical Diseases (TDR), World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1016\/S1473-3099(15)00149-8","article-title":"Out-of-pocket health expenditures and antimicrobial resistance in low-income and middle-income countries: An economic analysis","volume":"15","author":"Alsan","year":"2015","journal-title":"Lancet Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1080\/03009734.2016.1195900","article-title":"Antimicrobial resistance-a threat to the world\u2019s sustainable development","volume":"121","author":"Littmann","year":"2016","journal-title":"Ups. J. Med. Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1007\/s12668-019-00658-4","article-title":"World Health Organization Report: Current Crisis of Antibiotic Resistance","volume":"9","author":"Rizvanov","year":"2019","journal-title":"BioNanoScience"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis","volume":"399","author":"Murray","year":"2022","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3490","DOI":"10.1093\/jac\/dkx323","article-title":"Trends and patterns in antibiotic prescribing among out-of-hours primary care providers in England, 2010\u20132014","volume":"72","author":"Edelstein","year":"2017","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1287334","DOI":"10.1080\/16549716.2017.1287334","article-title":"Antibiotic prescribing for upper respiratory infections among children in rural China: A cross-sectional study of outpatient prescriptions","volume":"10","author":"Zhang","year":"2017","journal-title":"Glob. Health Action"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s13017-016-0089-y","article-title":"Antimicrobials: A global alliance for optimizing their rational use in intra-abdominal infections (AGORA)","volume":"11","author":"Sartelli","year":"2016","journal-title":"World J. Emerg. Surg."},{"key":"ref_8","unstructured":"IACG (2018). Future Global Governance for Antimicrobial Resistance, IACG."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Mhondoro, M., Ndlovu, N., Bangure, D., Juru, T., Gombe, N.T., Shambira, G., Nsubuga, P., and Tshimanga, M. (2019). Trends in antimicrobial resistance of bacterial pathogens in Harare, Zimbabwe, 2012\u20132017: A secondary dataset analysis. BMC Infect. Dis., 19.","DOI":"10.1186\/s12879-019-4295-6"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e15914","DOI":"10.1097\/MD.0000000000015914","article-title":"Correlation of antimicrobial prescription rate and county income in medicare part D","volume":"98","author":"Volpi","year":"2019","journal-title":"Medicine"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Abubakar, U. (2020). Antibiotic use among hospitalized patients in northern Nigeria: A multicenter point-prevalence survey. BMC Infect. Dis., 20.","DOI":"10.1186\/s12879-020-4815-4"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1007\/s40264-020-00920-9","article-title":"Patterns of Inpatient Antibiotic Use Among Public Hospitals in Hong Kong from 2000 to 2015","volume":"43","author":"Chui","year":"2020","journal-title":"Drug Saf."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.jegh.2014.06.003","article-title":"Point prevalence survey of antimicrobial utilization in a Canadian tertiary-care teaching hospital","volume":"5","author":"Lee","year":"2015","journal-title":"J. Epidemiol. Glob. Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/cid\/ciw658","article-title":"Measuring Appropriate Antimicrobial Use: Attempts at Opening the Black Box","volume":"63","author":"Spivak","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2525","DOI":"10.2147\/RMHP.S256648","article-title":"Prescribing for Patients Seeking Maternal and Child Healthcare in Sierra Leone: A Multiregional Retrospective Cross-Sectional Assessments of Prescribing Pattern Using WHO Drug Use Indicators","volume":"13","author":"Kabba","year":"2020","journal-title":"Risk Manag. Healthc. Policy"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"643","DOI":"10.2174\/1389201020666190408095811","article-title":"Healthcare-Associated Infections Due to Multidrug-Resistant Organisms: A Surveillance Study on Extra Hospital Stay and Direct Costs","volume":"20","author":"Giraldi","year":"2019","journal-title":"Curr. Pharm. Biotechnol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1016\/S0140-6736(20)32063-8","article-title":"Confronting antimicrobial resistance beyond the COVID-19 pandemic and the 2020 US election","volume":"396","author":"Strathdee","year":"2020","journal-title":"Lancet"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/s13690-017-0223-7","article-title":"Pandemics, public health emergencies and antimicrobial resistance-putting the threat in an epidemiologic and risk analysis context","volume":"75","author":"MacIntyre","year":"2017","journal-title":"Arch. Public Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"m1983","DOI":"10.1136\/bmj.m1983","article-title":"How COVID-19 is accelerating the threat of antimicrobial resistance","volume":"369","author":"Hsu","year":"2020","journal-title":"BMJ"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"m1557","DOI":"10.1136\/bmj.m1557","article-title":"Mitigating the wider health effects of COVID-19 pandemic response","volume":"369","author":"Douglas","year":"2020","journal-title":"BMJ"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.ijsu.2020.04.018","article-title":"The socio-economic implications of the coronavirus pandemic (COVID-19): A review","volume":"78","author":"Nicola","year":"2020","journal-title":"Int. J. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2327","DOI":"10.1056\/NEJMoa2007016","article-title":"Compassionate Use of Remdesivir for Patients with Severe COVID-19","volume":"382","author":"Grein","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_23","unstructured":"World Health Organization (2020). Therapeutics and COVID-19 Living Guideline, WHO."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1016\/j.jinf.2020.09.024","article-title":"Survey of antibiotic and antifungal prescribing in patients with suspected and confirmed COVID-19 in Scottish hospitals","volume":"81","author":"Seaton","year":"2020","journal-title":"J. Infect."},{"key":"ref_25","unstructured":"World Bank (2020, September 17). Current Health Expenditure (% of GDP)-Sierra Leone. Available online: https:\/\/data.worldbank.org\/indicator\/SH.XPD.CHEX.GD.ZS?locations=SL."},{"key":"ref_26","unstructured":"World Health Organization (2019). The 2019 WHO AWaRe Classification of Antibiotics for Evaluation and Monitoring of Use, World Health Organization."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1016\/j.cmi.2020.12.018","article-title":"Antibiotic prescribing in patients with COVID-19: Rapid review and meta-analysis","volume":"27","author":"Langford","year":"2021","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_28","unstructured":"Statistics Sierra Leone (2017). Sierra Leone 2015 Population and Housing Census: National Analytical Report."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s40545-019-0182-1","article-title":"Need to improve availability of \u201caccess\u201d group antibiotics and reduce the use of \"watch\" group antibiotics in India for optimum use of antibiotics to contain antimicrobial resistance","volume":"12","author":"Gandra","year":"2019","journal-title":"J. Pharm. Policy Pract."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e861","DOI":"10.1016\/S2214-109X(19)30071-3","article-title":"Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe): An analysis of paediatric survey data from 56 countries","volume":"7","author":"Hsia","year":"2019","journal-title":"Lancet Glob. Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"dlaa048","DOI":"10.1093\/jacamr\/dlaa048","article-title":"Community-level consumption of antibiotics according to the AWaRe (Access, Watch, Reserve) classification in rural Vietnam","volume":"2","author":"Nguyen","year":"2020","journal-title":"JAC-Antimicrob. Resist."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"92","DOI":"10.5897\/AJPP2021.5233","article-title":"Characteristics and pharmacological management of COVID-19 patients admitted at a hospital in Nairobi, Kenya","volume":"15","author":"Mariita","year":"2021","journal-title":"Afr. J. Pharm. Pharmacol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.jcrc.2020.03.005","article-title":"A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19","volume":"57","author":"Cortegiani","year":"2020","journal-title":"J. Crit. Care"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e000646","DOI":"10.1136\/bmjresp-2020-000646","article-title":"Characteristics and outcomes of admitted patients infected with SARS-CoV-2 in Uganda","volume":"7","author":"Kirenga","year":"2020","journal-title":"BMJ Open Respir. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"100134","DOI":"10.1016\/j.infpip.2021.100134","article-title":"Antibiotic Prescribing Patterns at COVID-19 Dedicated Wards in Bangladesh: Findings from a Single Center Study","volume":"3","author":"Molla","year":"2021","journal-title":"Infect. Prev. Pract."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Calder\u00f3n-Parra, J., Mui\u00f1o-Miguez, A., Bendala-Estrada, A.D., Ramos-Mart\u00ednez, A., Mu\u00f1ez-Rubio, E., Fern\u00e1ndez Carracedo, E., Tejada Montes, J., Rubio-Rivas, M., Arnalich-Fernandez, F., and Beato P\u00e9rez, J.L. (2021). Inappropriate antibiotic use in the COVID-19 era: Factors associated with inappropriate prescribing and secondary complications. Analysis of the registry SEMI-COVID. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0251340"},{"key":"ref_37","unstructured":"Martin, A.J., Shulder, S., Dobrzynski, D., Quartuccio, K., and Pillinger, K.E. (2021). Antibiotic use and associated risk factors for antibiotic prescribing in COVID-19 hospitalized patients. J. Pharm. Pract."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/S0140-6736(20)30211-7","article-title":"Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study","volume":"395","author":"Chen","year":"2020","journal-title":"Lancet"},{"key":"ref_39","first-page":"575","article-title":"Bacterial infection, antibiotic use and COVID-19: Lessons from the intensive care unit","volume":"111","author":"Moolla","year":"2021","journal-title":"S. Afr. Med. J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.jgar.2020.11.025","article-title":"A point prevalence survey to assess antibiotic prescribing in patients hospitalized with confirmed and suspected coronavirus disease 2019 (COVID-19)","volume":"24","author":"Tan","year":"2021","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s41182-021-00344-w","article-title":"The use of antibiotics in COVID-19 management: A rapid review of national treatment guidelines in 10 African countries","volume":"49","author":"Adebisi","year":"2021","journal-title":"Trop. Med. Health"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.jinf.2020.05.046","article-title":"Co-infections in people with COVID-19: A systematic review and meta-analysis","volume":"81","author":"Lansbury","year":"2020","journal-title":"J. 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