Pattern of Antibiotic Prescribing and Adherence to Antimicrobial Stewardship Guidelines in General Medicine: A Drug Utilization Study

Original Article

Abstract

Background: Inappropriate antibiotic prescribing contributes significantly to antimicrobial resistance, prolonged hospital stay, increased healthcare costs, and adverse drug reactions. Antimicrobial stewardship (AMS) programs promote the rational use of antibiotics and improve patient outcomes. Evaluating antibiotic utilization and adherence to stewardship recommendations is essential for optimizing prescribing practices in hospitalized patients.

Objective:To assess antibiotic prescribing practices and adherence to antimicrobial stewardship guidelines among patients admitted to the General Medicine Department of a tertiary care teaching hospital.

Methodology: This hospital-based cross-sectional drug utilization study was conducted in the Department of Community Medicine Department Khyber Medical College Peshawar.over a six-month period from 1 January 2025 to 30 June 2025, after obtaining approval from the Institutional Review Board (IRB). A total of 100 adult inpatients receiving at least one systemic antibiotic were enrolled using consecutive non-probability sampling. The sample size was calculated using the WHO sample size calculator, assuming a prevalence of 50%, a 95% confidence level, and a 10% margin of error, yielding a minimum sample size of 96 patients; therefore, 100 patients were included. Data regarding demographic characteristics, antibiotic prescriptions, indications, culture and sensitivity testing, adherence to antimicrobial stewardship recommendations, and clinical outcomes were collected using a structured proforma. Statistical analysis was performed using IBM SPSS Statistics version 27.0, and a p-value <0.05 was considered statistically significant.

Results:A total of 100 patients were included, comprising 96 (96%) males and 4 (4%) females, with a mean age of 51.8 ± 16.4 years. Respiratory tract infections were the most common indication for antibiotic therapy (43%), followed by skin and soft tissue infections (14%). Ceftriaxone was the most frequently prescribed antibiotic (61.5%), while combination antibiotic therapy was prescribed in 48% of patients. Culture and sensitivity testing was performed in 16% of cases. Overall, 79% of antibiotic prescriptions were adherent to antimicrobial stewardship recommendations, whereas 21% were non-adherent. Non-adherence was significantly associated with prolonged hospital stay (p = 0.018). Patients receiving guideline-adherent therapy demonstrated better clinical outcomes and lower rates of inappropriate antibiotic use.

Conclusion:Antibiotic prescribing practices in the General Medicine Department demonstrated satisfactory adherence to antimicrobial stewardship guidelines. However, opportunities remain to improve culture-guided therapy, optimize antibiotic selection, and strengthen antimicrobial stewardship interventions to further enhance prescribing quality and patient outcomes.