Antibiotic prescribing patterns and associated factors among outpatients in selected hospitals in Uganda

Background Antibiotics are among the most commonly prescribed pharmacological agents, and most of the antibiotic prescriptions are considered inappropriate. The WHO Global Action Plan and National Action Plan on antimicrobial resistance, strategizes routine monitoring of antibiotic prescribing practices for designing interventions to promote prudent use of antibiotics. This paper presents the findings of the national monitoring of antibiotic prescribing patterns and associated factors among outpatients for government and selected private hospitals in Uganda. Methods This was a cross-sectional study involving review of 14,929 patient records from 98 selected private and public hospitals in the four health regions of Uganda at the national, regional and district levels of care between August and December 2024. The data were extracted from the Ministry of Health National Health Data Warehouse using the Ministry of Health Prescription and Medicine Use Audit/Evaluation tool. The WHO standard methodology for conducting medicine use indicator surveys was followed during the data collection. Chi-square test and logistic regression analysis were performed to establish the associated factors with adherence to treatment guidelines. Variables with p values less than 0.05 at 95% confidence interval were considered statistically significant. Results The commonest indications for antibiotics were respiratory tract infections 19.0% (2,840), urinary tract infections 12.5% (1,860), and malaria 9.2% (1,375). The most commonly prescribed classes of antibiotics were nitroimidazoles 29.0% (5,296), penicillins 28.3% (5,170) and quinolones 12.2% (2,235). Most of the antibiotics prescribed belong to the Access category 67.8% as per WHO AWaRe classification. The percentage of prescription encounters with an antibiotic prescribed was 71.5% (10,675) and the percentage of antibiotic prescriptions by generic name was 61.5% (6,564). Adherence to standard treatment guidelines was 48.4%. The predictors of adherence to standard treatment guidelines were drug formulation prescribed (P>|t| 0.00, coefficient: -0.0858737, CI -0.1046333 to -0.0671141) and treatment based on biomarkers (P>|t| 0.00, coefficient: 0.142178, CI 0.1050591 to 0 .1792976). Conclusions There was a high rate of antibiotic prescriptions among outpatients with most of the prescriptions non-adherent to standard treatment guidelines. There is a need to enforce use of biomarkers and standard treatment guidelines while prescribing antibiotics.