Antimicrobial prescribing in acute care hospitals in the Middle East: a systematic review and meta-analysis of point-prevalence studies

Abstract

Abstract Background Understanding antimicrobial prescribing practices is a prerequisite for developing effective antimicrobial stewardship programs. A comprehensive analysis of point-prevalence studies of antimicrobial prescribing among hospitalised patients in the Middle East Region is currently lacking. Objectives To determine the pooled point-prevalence of antimicrobial prescribing among hospitalised patients in the Middle East Region, and to assess the indications, classes and types of antimicrobial agents prescribed. In addition, this study evaluated the quality indicators of antimicrobial prescribing. Methods This systematic review and meta-analysis adhered to the PRISMA 2020 Statement. Electronic bibliographic search was conducted on PubMed, Scopus and Google Scholar using antimicrobial/antibiotic prescribing, antimicrobial/antibiotic use, point-prevalence and the names of countries in the Middle East as search terms. Primary literature published in English language describing the point-prevalence and types of antimicrobial prescribing in inpatients from the inception of the databases to December 2025 were included. Data were synthesised using qualitative and quantitative methods. RevMan version 5.4 was used for a random-effect meta-analysis. Results Thirty-one eligible studies out of 1515 identified studies were included with most studies conducted in Saudi Arabia ( n = 7) and Turkey ( n = 6). The pooled point-prevalence of antimicrobial prescribing was 58.6% (95% confidence interval [CI]: 51.89–65.36) with the pooled point-prevalence ranging from 82.9% (95% CI: 64.86–100.96) in Iraq to 43.5% (95% CI: 23.22–63.77) in the UAE. The pooled rate of combination therapy and parenteral antimicrobial prescribing was 40.8% and 82.2%, respectively. The indications for antimicrobial prescribing were community-acquired infections (40.5%), surgical antimicrobial prophylaxis (SAP) (21.3%), hospital-acquired infections (17.7%) and medical prophylaxis (9.4%). Third generation cephalosporin (22.4%), penicillin beta-lactamase inhibitor combination (14.4%) and carbapenems (10.3%) were the most prescribed class of antibiotics. The pooled prevalence of Access, Watch and Reserve antibiotics prescribing was 30.0%, 56.2% and 6.9%, respectively. Reason for antimicrobial prescription and stop/review date was documented in 69.0% and 40.7% of the prescriptions, respectively. Prolonged duration of SAP was common among the patients (79%). Conclusion Antimicrobial prescribing among hospitalised patients in the Middle East was high and varied between countries. There was a high rate of watch and reserve antibiotics prescribing. Prolonged duration of SAP was common. The results indicate the need to strengthen antimicrobial stewardship programs in inpatient settings to improve the quality use of antimicrobial agents in the region.