Alarming Antimicrobial Prescribing Patterns at a Tertiary Hospital in Nigeria: A Point Prevalence Survey using the Global-PPS Protocol

Background: Antimicrobial resistance is a critical threat in Nigeria, where inappropriate prescribing remains one of the major drivers. This study evaluated antimicrobial use patterns at Usmanu Danfodiyo University Teaching Hospital (UDUTH) using the Global Point Prevalence Survey methodology. Methodology: A cross-sectional survey was conducted October 21-25, 2024 across all inpatient wards using standardized GPPS protocols. Data collectors received virtual training through the Fleming Fund project. All patients admitted before 8:00 AM on survey days were included, with data collected on antimicrobial prescriptions, indications, and quality indicators. Results: A total of 262 inpatients were surveyed, with 195 prescribed antimicrobials, yielding a high overall prevalence of 74.4%. Ward-specific analysis revealed statistically significant variation: Neonatal wards had universal use (23/23, 100%; p<0.001), significantly higher than Adult Medical (50/79, 63.2%; p<0.001) and Paediatric Surgical (24/39, 61.5%; p=0.002) wards. Paediatric Medical ward use (33/36, 91.7%; p<0.001) was also significantly higher. The high rates in Adult Surgical (44/53, 83.0%) and Adult Intensive Care (15/18, 83.3%) wards were not statistically significant (p>0.05) from the hospital average. A total of 437 antimicrobial agents were prescribed which was dominated by antibacterials (310/437, 71.0%), primarily third-generation cephalosporins (83/310, 26.9%). Empiric therapy accounted for 85.7% of treatments. Critical documentation gaps and low guideline compliance (medical: 11.5%; surgical: 1.6%) were observed. AWaRe classification showed 61.0% Watch antibiotic use, and 37.5% (164/437) of prescribed doses were missed, primarily due to patients inability to afford (120/164, 73.2%) Conclusion: UDUTH exhibits excessive antimicrobial use with significant, non-random inter-ward variation, dominated by broad-spectrum agents and poor prescribing quality. These findings stress an urgent need for targeted antimicrobial stewardship programs, strengthen diagnostic infrastructures, and policies to ensure affordable access.