Chapuma, Chikondi 
ORCID: 0000-0002-3363-3205, Kamchedzera, Wala ORCID: 0000-0002-6709-4270, Weeks, Andrew ORCID: 0000-0002-1909-337X, Jafali, James, Mndala, Leonard ORCID: 0000-0003-0488-6972, Masoamphambe, Effita, Kulapani, David and Otieku, Evans ORCID: 0000-0002-6809-5160
(2025)
The “readily available” second-line antibiotics are more cost-effective than the “easily accessible” first-line antibiotics as the initial management of Urinary Tract Infections and Chorioamnionitis in Malawi
Wellcome Open Research, 10.
p. 251.
ISSN 2398-502X, 2398-502X
Abstract
<h4>Background: </h4> Antimicrobial resistance (AMR) has health and economic implications for patients, healthcare providers, and the society. In Malawi, infections, including AMR, account for 22% of the maternal mortality. Economic evaluation of AMR is required to understand the cost-benefits of bacterial infection treatment strategies and antibiotic prescriptions for maternal infections and AMR. Notably, evidence of the comparative cost-effectiveness of commonly used antibiotics for maternal infection treatment is scarce. Methods Using a decision tree model, we assessed the cost-effectiveness of second-line antibiotics (ciprofloxacin and ceftriaxone) against first-line antibiotics (amoxicillin, gentamicin, and ampicillin) for the management of maternal infections in Malawi. The analysis considered both outpatient (urinary tract infection) and inpatient (chorioamnionitis) scenarios. Results The results indicate that the “readily available” second-line antibiotics have a cost advantage, with incremental-cost-effectiveness-ratios (ICERs) below Malawi's GDP per capita (634.8 USD/ capita). A total of 0.157cents per infection were resolved for urinary tract infection and 0.673 cents per infection were resolved for chorioamnionitis. Conclusion This study provides insights for assessing the cost-effectiveness of antibiotic treatment strategies in Malawi and other similar low-resource settings. It suggests healthcare providers should consider the cost advantage and clinical consequence when: 1) prescribing “readily available"and easily accessible antibiotics for treatment of maternal bacterial infections like UTI and chorioamnionitis, and 2) transitioning patients with unresolved bacterial infection from first-line antibiotics to second-line antibiotics that are both available and accessible.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | 3207 Medical Microbiology, 32 Biomedical and Clinical Sciences, Women's Health, Emerging Infectious Diseases, Urologic Diseases, Biodefense, Clinical Research, Cost Effectiveness Research, Infectious Diseases, Antimicrobial Resistance, Comparative Effectiveness Research, Health Services, Infection, 3 Good Health and Well Being |
| Divisions: | Faculty of Health & Life Sciences Faculty of Health & Life Sciences > Inst. Life Courses & Medical Sciences Faculty of Health & Life Sciences > Inst. Life Courses & Medical Sciences > Inst. Life Courses & Medical Sciences Faculty of Health & Life Sciences > Inst. Life Courses & Medical Sciences > Inst. Life Courses & Medical Sciences (T&R staff) Faculty of Health & Life Sciences > Inst. Life Courses & Medical Sciences > Women's & Children's Health |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 01 Dec 2025 09:06 |
| Last Modified: | 12 Dec 2025 17:57 |
| DOI: | 10.12688/wellcomeopenres.24007.1 |
| Open Access URL: | https://wellcomeopenresearch.org/articles/10-251/v... |
| Related Websites: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3195732 |
| Disclaimer: | The University of Liverpool is not responsible for content contained on other websites from links within repository metadata. Please contact us if you notice anything that appears incorrect or inappropriate. |
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