Evaluation of the clinical practice of aminoglycoside use in paediatric patients in Kenya: findings and implications for lower-middle income countries

Elias Joseph Onyango; Faith Okalebo; Margaret Oluka; Rosaline Kinuthia; Loice Achieng; Brian Godman; Amanj Kurdi

doi:10.1093/jacamr/dlz087

Evaluation of the clinical practice of aminoglycoside use in paediatric patients in Kenya: findings and implications for lower-middle income countries

JAC Antimicrob Resist. 2020 Jan 27;2(1):dlz087. doi: 10.1093/jacamr/dlz087. eCollection 2020 Mar.

Authors

Elias Joseph Onyango¹, Faith Okalebo¹, Margaret Oluka¹, Rosaline Kinuthia², Loice Achieng¹, Brian Godman^{3

4

5}, Amanj Kurdi^{3

6}

Affiliations

¹ University of Nairobi, PO Box 19676 NAIROBI - 00202 KNH, Nairobi, Kenya.
² Kenyatta National Hospital, PO Box 20723, Hospital Rd, Nairobi, Kenya.
³ Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde, 16 Richmond Street, Glasgow G1 1XQ, Scotland.
⁴ Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa.
⁵ Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.
⁶ Department of Pharmacology and Toxicology, College of Pharmacy, Hawler Medical University, Erbil, Iraq.

Abstract

Objectives: To evaluate the practice of aminoglycoside use/monitoring in Kenya and explore healthcare worker (HCW) perceptions of aminoglycoside monitoring to identify gaps and opportunities for future improvements, given the low therapeutic index of aminoglycosides.

Methods: This was a two-phase study whereby we reviewed patients' medical records at Kenyatta National Hospital (October-December 2016) in Phase 1 and interviewed HCWs face to face in Phase 2. Outcome measures included describing and evaluating the practice of aminoglycoside use and monitoring and compliance to guidelines. Data were analysed using descriptive and inferential analysis.

Results: Overall, out of the 2318 patients admitted, 192 patients (8.3%) were prescribed an aminoglycoside, of which 102 (53.1%) had aminoglycoside doses that did not conform to national guidelines. Aminoglycoside-related adverse effects were suspected in 65 (33.9%) patients. Monitoring of aminoglycoside therapy was performed in only 17 (8.9%) patients, with no therapeutic drug monitoring (TDM), attributed mainly to knowledge and skill gaps and lack of resources. Out of the 28 recruited HCWs, 18 (64.3%) needed training in how to perform and interpret TDM results.

Conclusions: The practice of using and monitoring aminoglycosides was suboptimal, raising concerns around potential avoidable harm to patients. The identified gaps could form the basis for developing strategies to improve the future use of aminoglycosides, not only in Kenya but also in other countries with similar settings and resources.