Addressing Pediatric Antimicrobial Resistance in Ghana: Strategies and Solutions

Antimicrobial resistance among Ghanaian children is escalating into a silent crisis, with ward-level audits reporting high rates of inappropriate pediatric antibiotic use.

Clinicians wrestle with empiric therapy decisions for neonatal sepsis and pneumonia management amid limited diagnostic support. Recent registry data demonstrate that audit-and-feedback initiatives have shown modest gains, though integration of local microbiology data could enhance impact; in a multicenter trial, context-adapted stewardship programs reduced broad-spectrum antibiotic days by 25% when prescribers received regular antibiogram-guided feedback.

Ghana’s rollout of free maternal healthcare has been associated with reduced infection rates and fewer empiric antibiotic starts, according to analysis of healthcare outcomes.

A related challenge arises when measuring antibiotic appropriateness at scale. Electronic health records paired with point-of-care diagnostics can flag mismatches in spectrum or duration of therapy. An automated-metrics framework correlated prescribing patterns with potential adverse outcomes, offering a scalable dashboard for stewardship teams to monitor hospital antibiotic utilization.

Elsewhere, Ceftriaxone usage has emerged as an indicator of over-prescription. Audits indicate that third-generation cephalosporins are among the most commonly prescribed pediatric antibiotics in some facilities, associated with resistance in Enterobacteriaceae. A clinical review on ceftriaxone overuse linked high consumption rates with escalating cephalosporin-resistant E. coli isolates.

Understanding underlying resistance mechanisms unveils paths to adjunctive therapies. Investigations into efflux pumps that expel antibiotics in Enterobacteriaceae have identified promising inhibitors that could restore antibiotic susceptibility. Recent research on efflux-mediated resistance highlights opportunities to integrate novel compounds into stewardship protocols and drug development pipelines.

Sustainable pediatric antibiotic stewardship in Ghana will hinge on aligning national strategies with facility-level protocols, empowering clinicians through targeted education, and investing in diagnostic infrastructure. As resistance trends evolve across regions, access to rapid testing can help refine empiric choices for conditions like neonatal sepsis and severe pneumonia. What remains unclear is the most effective model for scaling these interventions across diverse district hospitals and sustaining behavior change among prescribers.

Key Takeaways:

• Locally tailored stewardship programs are crucial for mitigating antibiotic resistance in Ghanaian children.
• Ghana healthcare policies, including free maternal care, indirectly influence pediatric antibiotic resistance patterns and should align with stewardship objectives.
• Technological tools such as electronic health records and point-of-care testing enhance monitoring of antibiotic appropriateness and hospital antibiotic utilization.
• Advancing our understanding of bacterial resistance mechanisms, particularly efflux pumps, is essential for developing adjunctive therapies and long-term stewardship success.