Development and Implementation of Mobile Antibiograms to Optimize Empirical Antibiotic Prescriptions Among Prescribers in Tertiary Hospitals in Tanzania (AMR; AMU; DDD)

Enhancing the Optimization of Empirical Antibiotic Therapy: Development and Implementation of Mobile Antibiograms in Tertiary Hospitals in Tanzania

Antimicrobial resistance (AMR) is a critical issue, especially in Africa, with resistance to common antibiotics reaching 100% in some areas. In Tanzania, limited access to culture tests and antibiograms forces healthcare providers to rely on experience for prescribing, heightening AMR risks. This study aims to determine the effectiveness of mobile antibiograms in optimizing empirical antibiotic therapy in tertiary hospitals in Tanzania.

Study Overview

• Status: Not yet recruiting
• Conditions: Antimicrobial Resistance (AMR); Antimicrobial Prescribing Practices
• Intervention / Treatment: Other: standard of care; Other: Mobile antibiogram application

Detailed Description

A pragmatic quasi-experimental design (hybrid type 1 trial) will be used to evaluate the effectiveness of mobile antibiograms on antibiotic use. The key role of the antibiogram is to guide empirical treatment of symptomatic infections using antibiotics ie., the antibiogram contains a list of susceptible and resistant antibiotics enabling the prescriber to rationally choose the antibiotic which is effective in clearing the infection. The study employs a three-phase, stepwise approach to assess and enhance antimicrobial use in Tanzanian hospitals. The first phase will be a baseline assessment using World Health Organization's Point Prevalence Survey and defined daily dose (DDD) to determine the pattern of antibiotic utilization and consumption respectively. The second phase involves developing a mobile antibiogram application through a participatory design with healthcare stakeholders. The final phase will use a quasi-experimental design to test the effectiveness of the mobile antibiogram on antimicrobial stewardship metrics like DDD per 1000 patient days, antibiotic appropriateness, infection-related mortality and length of hospital stay. The study sites will be Mbeya Zonal Referral Hospital (MZRH) as the intervention group and Benjamini Mkapa Hospital (BMH) as the control group. Additionally, a mixed-methods design (explanatory sequential design) will be used to assess the acceptability, feasibility, and adoption of the mobile antibiograms.

• Study Type: Interventional
• Enrollment (Estimated): 300
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Alphonce Ignace Marealle, PhD; Phone Number: +255713629365; Email: marealle2010@gmail.com
• Study Contact Backup: Name: Wigilya Padili Mikomangwa, MSc; Email: wpad.miko@gmail.com

Study Locations

• Tanzania
  • Dodoma, Tanzania
    • Benjamin Mkapa Hospital
    • Contact: Farida Khalifa Mbura, Microbiology and Immunology; Email: faridambura1975@gmail.com
  • Mbeya, Tanzania
    • Mbeya Zonal Referral Hospital
    • Contact: Anthony A Nsojo, MD; MMED; Email: ansojo43@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion criteria

1. All prescribers working in the selected tertiary referral hospitals
2. All prescribers owning smartphones
3. Prescribers who consent to take part in the study

Exclusion criteria

1. Temporarily employed prescribers

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: standard of care; Participants will be subjected to manual antibiogram which is the standard of care to guide the empirical prescription of antibiotics	Other: standard of care; Participants will be assigned to manual antibiogram only.
Experimental: Mobile antibiogram; Participants will be assigned to the mobile antibiogram application to guide the empirical prescription of antibiotics in addition to standard of care.	Other: Mobile antibiogram application; A mobile antibiogram application software containing antibiotic sensitivity test results specific to the health facility. This mobile antibiogram application will guide decision support for empirical prescription.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pattern of antibiotic use	Proportional change in antibiotic use among admitted patients	12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pattern of antibiotic resistance	Number of resistances to antibiotics among admitted patients	12 months
Acceptability of mobile antibiograms	% of acceptability of mobile antibiograms among prescribers	12 months
Feasibility of mobile antibiograms	% of feasibility mobile antibiogram among prescribers in tertiary referral hospitals in Tanzania	12 months
Adoption of mobile antibiogram	% of adoption of mobile antibiogram among prescribers in tertiary referral hospitals in Tanzania	12 months

Collaborators and Investigators

• Sponsor: Muhimbili University of Health and Allied Sciences

Publications and helpful links

General Publications

• Zimbwe KB, Yona YJ, Chiwambo CA, Chandika AB, Kiwelu HS, Shabani MM. Trends and patterns of antimicrobial consumption at Benjamin Mkapa Zonal Referral Hospital, Dodoma, Tanzania: a cross-sectional retrospective analysis. BMJ Open. 2024 Nov 13;14(11):e083842. doi: 10.1136/bmjopen-2023-083842.
• Shinohara KI, Yasuda S, Kato G, Fujita M, Shigekawa H. Direct measurement of the chiral quaternary structure in a pi-conjugated polymer at room temperature. J Am Chem Soc. 2001 Apr 18;123(15):3619-20. doi: 10.1021/ja003023m. No abstract available.
• Mutagonda RF, Marealle AI, Nkinda L, Kibwana U, Maganda BA, Njiro BJ, Ndumwa HP, Kilonzi M, Mikomangwa WP, Mlyuka HJ, Felix FF, Myemba DT, Mwakawanga DL, Sambayi G, Kunambi PP, Ndayishimiye P, Sirili N, Mfaume R, Nshau A, Nyankesha E, Scherpbier R, Bwire GM. Determinants of misuse of antibiotics among parents of children attending clinics in regional referral hospitals in Tanzania. Sci Rep. 2022 Mar 22;12(1):4836. doi: 10.1038/s41598-022-08895-6.
• Minzi OM, Kilonzi M, Mikomangwa WP, Bwire GM, Myemba DT, Marealle AI, Mlyuka HJ, Kibanga W, Mutagonda RF, Mwambete K. Update on bacterial and antibiotic susceptibility profiles among patients attending a tertiary referral hospital in Tanzania. J Glob Antimicrob Resist. 2021 Jun;25:87-88. doi: 10.1016/j.jgar.2021.02.030. Epub 2021 Mar 13. No abstract available.
• Nkinda L, Mwakawanga DL, Kibwana UO, Mikomangwa WP, Myemba DT, Sirili N, Mwakalukwa R, Kilonzi M, Sambayi G, Maganda BA, Njiro BJ, Ndumwa HP, Mutagonda R, Marealle AI, Felix FF, Mlyuka HJ, Makuka G, Kubigwa SW, Kunambi PP, Mfaume R, Nshau AB, Bwire GM, Scherpbier R, Nyankesha E. Implementation of antibiotic stewardship programmes in paediatric patients in regional referral hospitals in Tanzania: experience from prescribers and dispensers. JAC Antimicrob Resist. 2022 Nov 23;4(6):dlac118. doi: 10.1093/jacamr/dlac118. eCollection 2022 Dec.
• Costa-Paz M, Muscolo DL, Ayerza M, Makino A, Aponte-Tinao L. Magnetic resonance imaging follow-up study of bone bruises associated with anterior cruciate ligament ruptures. Arthroscopy. 2001 May;17(5):445-9. doi: 10.1053/jars.2001.23581.
• Guerrier C, Wartanian R, Boblet V, Rohmer E, Le Lirzin R. [Cervical pregnancy. Contribution of ultrasonography to diagnosis and therapeutic management]. Rev Fr Gynecol Obstet. 1995 Jul-Sep;90(7-9):352, 355-9. French.
• Fukunaga M, Tanaka C, Umeda M, Ebisu T, Aoki I, Watanabe Y, Higuchi T, Naruse S. Comparison of supplementary motor area activation between simple and complex motor task. Electroencephalogr Clin Neurophysiol Suppl. 1996;47:265-9. No abstract available.
• Dorward AJ, Stack BH. Diffuse malignant pleural mesothelioma in Glasgow. Br J Dis Chest. 1981 Oct;75(4):397-402. doi: 10.1016/0007-0971(81)90027-9.

Study record dates

Study Major Dates

• Study Start (Estimated): February 1, 2026
• Primary Completion (Estimated): June 30, 2027
• Study Completion (Estimated): June 30, 2028

Study Registration Dates

• First Submitted: January 21, 2026
• First Submitted That Met QC Criteria: January 30, 2026
• First Posted (Actual): February 6, 2026

Study Record Updates

• Last Update Posted (Actual): February 6, 2026
• Last Update Submitted That Met QC Criteria: January 30, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Health Services Administration; Health Care Quality, Access, and Evaluation; Quality of Health Care; Quality Indicators, Health Care; Standard of Care
• Other Study ID Numbers: MUHAS-REC-10-2025-3152; 224127 (Other Grant/Funding Number: GSK Africa Open Lab)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No