Antibiotic Use among Patients Treated for Malaria in Tertiary Hospitals in Uganda

Introduction: Inappropriate antibiotic use is a major contributor to antimicrobial resistance (AMR) worldwide, especially in settings with high disease burden. This study used data from Point Prevalence Survey (PPS) to determine the rate and factors associated with antibiotic use among hospitalized patients diagnosed with malaria in selected regional referral hospitals in Uganda. Methods We conducted a secondary analysis of antibiotic use data from PPS conducted between October 2020 and November 2023 at nine regional referral hospitals across Uganda. Data from 1,092 patient records with malaria diagnosis were analyzed. We defined non-adherence to standard treatment guidelines as any antibiotic prescription that was not compliant with one or more of the 5Rs of Antimicrobial Stewardship (AMS) and used a modified Poisson regression to estimate prevalence ratios (PRs) for factors associated with non-adherence to national antibiotic prescribing guidelines. Results We reviewed 9,008 records, among which 1,092 (12%) had malaria as part of the diagnosis. Among the 1,092, the median age was 7 (IQR:3–16), 581 (53%) were female, 738 (68%) were admitted in pediatric wards, and 464 (42%) received antibiotic prescriptions that were not adherent to national guidelines. Non-adherence to the Uganda Clinical Guidelines varied significantly, with the highest level (48%) observed in the medical ward. “Other” was the most common indication for non-adherent antibiotic prescription. The majority (61%) of the prescribed antibiotics fell into the Watch category of the WHO AWaRe classification, with 923 (82%) of all prescriptions being made by general practitioners. Multivariable analysis indicated that medical prophylaxis (aPR = 1.81, 95% CI = 1.47–2.24), having an infectious syndrome (aPR = 2.15, 95% CI = 1.76–2.63), and other indications (aPR = 1.97, 95% CI = 1.65–2.37) were significantly associated with non-adherence to national guidelines Conclusion Nearly half of malaria patients received antibiotics outside the national prescription guidelines, often for non-specific indications, mostly by general practitioners. Targeted stewardship interventions, such as prescriber training, improved point-of-care diagnostics, routine audits and feedback, and integration of stewardship support in malaria programing, are essential to optimizing antibiotic use and combating AMR.