Evaluation of inpatient antibiotic prescribing patterns using WHO indicators in Northern Ethiopia: a prospective cross-sectional study identifying stewardship gaps

Abstract

OBJECTIVE: This study aimed to evaluate inpatient antibiotic prescribing patterns and identify antimicrobial stewardship (AMS) gaps using World Health Organization (WHO) antibiotic use indicators at Ayder Comprehensive Specialized Hospital (ACSH), a major tertiary hospital in Northern Ethiopia. RESULTS: Among 1,684 admitted patients, 865 (51.4%) received at least one antibiotic. A total of 1,491 antibiotics were prescribed, with a mean of 1.7 ± 0.7 antibiotics per patient and an average treatment duration of 5.9 ± 3.9 days. Nearly all antibiotics were prescribed by generic name (98.9%) and from the national Essential Medicines List (100%). Injectable formulations accounted for 90.9% of prescriptions. Ceftriaxone (41.0%), metronidazole (21.9%), and vancomycin (9.4%) were the most commonly used antibiotics. Watch-class antibiotics constituted 64.1% of prescriptions. More than half of antibiotic use was for therapeutic purposes (54.3%), of which 95.5% was empirical. Culture testing was performed in only 2.4% of patients, and antimicrobial susceptibility testing in 0.3%. Stock-outs affected 24.3% of antibiotics, with a mean duration of 4.8 days per month. Longer hospital stays, comorbidities, and severe clinical conditions, including sepsis and pneumonia, were associated with increased antibiotic use.