Authors:
Abdoulaye Diawara*, Sirima Niaré
, Balla Coulibaly
, Aminata Maïga
and Sidy Ba, Mali |
Abstract:
The consumption of antibiotics in hospitals in Mali is remarkable. The large hospitals at the top
of the country's health pyramid are at the heart of this problem. The objective of this study
remains the analysis of antibiotic consumption in five large hospitals in Bamako during 2018-
2020 and to measure the concentration of antibiotics in the Niger River through hospital effluent
discharges. The penetration index was chosen as a tool to measure antibiotic exposure. It takes
into account the total amount in grams of antibiotics divided by the Defined Daily Dose
established by the WHO. Liquid chromatography in tandem with a mass spectrometer was used
to detect and measure the concentration of antibiotics in the effluent in the environment. Three
families of antibiotics, including beta-lactam (69%), fluoroquinolones (22%) and macrolides
(17%), have brought hospitals together to prescribe antibiotics, in this case amoxicillin (157.6
DD/1000), ciprofloxacin (128.8 DD/1000) and erythromycin (222.4 DD/1000). Effluent
concentrations averaged 6.06 ?g/L of amoxicillin, 24.9 ?g/L of ciprofloxacin and 1.38 ?g/L of
erythromycin. The occurrence of antibiotic detection was on average (> 70%).About 20% of the
total antibiotic load through hospital effluent was sent directly into the Niger River; 50% via
sewage systems and the rest through runoff and infiltration. Optimizing antibiotic prescribing
and setting up a national network for monitoring and analyzing antimicrobial consumption are
necessary to rationalize antibiotic consumption.
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