title: Prevalence and predictors of prior antibacterial use among patients presenting to hospitals in Northern Uganda.
abstract: BACKGROUND
  Human antibacterial exposure occur in different ways including consumption of animal and agricultural products as well as use of prescribed and non-prescribed agents. We estimated the prevalence and explored the predictors of antibacterial use among patients presenting to hospitals in northern Uganda.
  
  
  METHODS
  Four hundred fifty (450) patients were randomly selected and antibacterial use prior to hospital visit measured using a questionnaire and urine antibacterial activity assay. Urine antibacterial bioassays were performed using American type culture collections of Escherichia coli, Bacillus subtilis and Streptococcus pyogenes. Data were analysed using STATA 12.0 at 95% confidence level.
  
  
  RESULTS
  Of 450 patients interviewed, 62.2% had used antibacterial agents. Urine antibacterial activity was detected in 30.4% of the samples tested. Of the 85 patients who reported not taking any antibacterial at home, 16 (18.8%) had urine with antibacterial activity. Most test bacteria, E. coli (74.5%), B. subtilis (72.6%) and S. pyogens (86.7%) were sensitive to urine of patients who reported using antibacterial drugs before hospital visit. From the interview, metronidazole 15.6% (70/450), amoxicillin 12% (54/450), and ciprofloxacin 10.4% (47/450) were the most used antibacterial agents. Patient age (OR, 2.45: 95% CI: 1.02-5.91: P = 0.024), time-lag between last drug intake and hospital visit (OR: 3.18: 95% CI: 1.44-7.0: P < 0.0001), and time-lag between illness onset and hospital visit (OR: 1.89: 95% CI: 0.38-5.1: P = 0.027) predicted the use of antibacterial agents before hospital visit.
  
  
  CONCLUSIONS
  Community antibacterial use continues to take place in an unregulated manner. In addition, physiciansrarely seek to ascertain prior use of antibacterial agents among patients presenting to hospitals. This couldhave a bearing on patient treatment outcomes.
  
  
  CONCLUSIONS
  Knowledge of prior antibacterial use among patients presenting to hospitals is useful to physicians in ensuring antibacterial stewardship.
authors.affiliation: Department of Pharmacology & Therapeutics, Makerere University, P.O. Box 7072, Kampala, Uganda. mss_ocan@yahoo.co.uk.
authors.forename: Moses
authors.initials: M
authors.lastname: Ocan
authors.affiliation: Division of Infectious Diseases Department of Medicine, Johns Hopkins School of Medicine, Baltimore, USA. ymanabe@jhmi.edu.
authors.forename: Yukari C
authors.initials: YC
authors.lastname: Manabe
authors.affiliation: Department of Clinical Microbiology, Makerere University, P.O. Box 7072, Kampala, Uganda. hanzbtasi@gmail.com.
authors.forename: Hannington
authors.initials: H
authors.lastname: Baluku
authors.affiliation: Mild may Uganda, P. O. Box 24985, Kampala, Uganda. atukesie@gmail.com.
authors.forename: Esther
authors.initials: E
authors.lastname: Atukwase
authors.affiliation: Faculty of medicine, Gulu University, P.O. Box 166, Gulu, Uganda. jogwal.okeng@gmail.com.
authors.forename: Jasper
authors.initials: J
authors.lastname: Ogwal-Okeng
authors.affiliation: Department of Pharmacology & Therapeutics, Makerere University, P.O. Box 7072, Kampala, Uganda. cobua1953@gmail.com.
authors.forename: Celestino
authors.initials: C
authors.lastname: Obua
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use* / Q000652:urine; D001412:Bacillus subtilis / Q000187:drug effects; D001419:Bacteria / Q000145:classification / Q000187:drug effects*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004926:Escherichia coli / Q000187:drug effects; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D013297:Streptococcus pyogenes / Q000187:drug effects; D011795:Surveys and Questionnaires; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents