A multicenter point-prevalence survey of antibiotic utilization patterns in Ethiopia: implications for strengthening stewardship programs

The emerging of antimicrobial resistant strains is destroying the paradigm-shifting power of antibiotics. The main driver of antimicrobial resistance inappropriate prescribing practices, primarily in institutions like Sub-Saharan Africa. Hence, this study aims to evaluate real antibiotic use patterns among inpatients at four public hospitals in Jimma, Ethiopia. Across-sectional point prevalence survey using standardized World Health Organization (WHO)’s point-prevalence survey (PPS) was employed to conduct this study in August 2023. All hospitalized patients at adult and pediatric wards before or at 08:00 on the survey date were enrolled. Data collection tool was adopted and customized to collect hospital antibiotic use pattern using a standardized PPS method. Data were collected using Open Data Kit (ODK) and analyzed using SPSS version 27; where the p-value < 0.05 was considered statistically significant. A total of 344 patients were enrolled, with a male predominance (57.6%) and a majority (58.4%) aged over 18 years. The common clinical indications for antibiotic prescriptions were gastrointestinal infections (28.5%) followed by Respiratory tract (upper and lower) infections (27.4%). The antibiotics were mainly indicated for therapeutic purpose (59.3%). The antibiotic use prevalence was 85.8% with high rate (59.0%) of patients were receive “Watch” group antibiotics mainly from cephalosporin class. Empirical therapy was the predominant treatment approach (95.3%), with ceftriaxone being the most frequently prescribed agent, accounting for 43.3% of all empirical antibiotic use. Surgical prophylaxis accounted for the majority (88%) of prophylactic antibiotic use. Notably, nearly three-quarters (74%) of these patients received prophylaxis for longer than the recommended 24-hours. Only 4.0% of patients receiving parenteral antibiotics were switched to oral therapy. Furthermore, 37.1% of prescriptions deviated from guideline recommendations or lacked documentation to assess adherence. The treatment approach was rarely evidence-based, with microbiological testing absent in 90% of cases. Of patients who had culture results, gram-negative bacteria (e.g., E. coli, Klebsiella spp., Citrobacter spp.) were a common bacterial isolates. Multivariable analysis showed that surgical procedures (AOR = 5.96) and peripheral catheters (AOR = 6.81) were significantly associated with increased antibiotic use. The findings reveal alarmingly high antibiotic utilization in Ethiopian hospitals, primarily driven by excessive empirical prescribing, insufficient microbiological testing, and inappropriate and prolonged surgical prophylaxis. These results highlight the urgent need for multifaceted interventions, including strengthening diagnostic capabilities to support evidence-based prescribing, implementing robust antimicrobial stewardship programs with regular ward-level audits, and ensuring strict adherence to treatment guidelines.