Evaluation of Prescription Patterns and Consumption of Antibiotics Using WHO Methodologies at Ayder Comprehensive Specialized Hospital, Northern Ethiopia: The Need for Stewardship

Background Antibiotics remain vital for managing bacterial infections; however, their misuse contributes significantly to the rise of antimicrobial resistance (AMR). To guide stewardship and slow resistance, the World Health Organization (WHO) urges regular monitoring of hospital antibiotic use using the Access, Watch, Reserve (AWaRe) analysis, defined daily dose (DDD) metrics, and the drug utilization 90% (DU90%) index. However, evidence on the patterns of inpatient antibiotic use and consumption in Ethiopia remains limited. This study, therefore, assessed prescribing patterns and consumption at Ayder Comprehensive Specialized Hospital, Northern Ethiopia. Methods A prospective cross-sectional study was conducted among inpatients receiving antibiotics in medical, surgical, pediatric, and gynecology/obstetrics wards between June and September 2024. Prescriptions were evaluated using the WHO-AWaRe classification, whereas consumption was measured in DDD/100 bed-days and the DU90% index. The data were analysed descriptively. Results Among 865 inpatients, 1,491 antibiotic prescriptions were recorded. Ceftriaxone (41%), metronidazole (21.9%), and vancomycin (9.4%) were the most commonly prescribed antibiotics. Watch antibiotics accounted for 63.1% of prescriptions, Access 35.9%, and Reserve 1.0%, deviating from the WHO recommendation that ≥ 60% should be from Access. The total antibiotic consumption was 180.1 DDD/100 bed-days, with ceftriaxone (73.2), metronidazole (45.7), and vancomycin (19.5) dominating. The DU90% segment included five antibiotics (ceftriaxone, metronidazole, vancomycin, ceftazidime, and azithromycin), which together accounted for 91.4% of the total consumption. Conclusion Antibiotic prescription at this major comprehensive specialized hospital was dominated by Watch antibiotics, particularly ceftriaxone, with overall consumption rates higher than those reported in many regional and global studies. These findings highlight inappropriate antibiotic use and emphasize the need for strengthened antimicrobial stewardship programs in Ethiopian hospitals.