Evaluation of inpatient antibiotic prescribing patterns using WHO indicators in Northern Ethiopia: a prospective cross-sectional study identifying stewardship gaps

Objective This study aimed to evaluate inpatient antibiotic prescribing patterns and identify antimicrobial stewardship (AMS) gaps using World Health Organization (WHO) antibiotic use indicators at Ayder Comprehensive Specialized Hospital (ACSH), a major tertiary hospital in Northern Ethiopia. Results Among 1,684 admitted patients, 865 (51.4%) received at least one antibiotic. A total of 1,491 antibiotics were prescribed, with a mean of 1.7 ± 0.7 antibiotics per patient and an average treatment duration of 5.9 ± 3.9 days. Nearly all antibiotics were prescribed by generic name (98.9%) and from the national Essential Medicines List (100%). Injectable formulations accounted for 90.9% of prescriptions. Ceftriaxone (41.0%), metronidazole (21.9%), and vancomycin (9.4%) were the most commonly used antibiotics. Watch-class antibiotics constituted 64.1% of prescriptions. More than half of antibiotic use was for therapeutic purposes (54.3%), of which 95.5% was empirical. Culture testing was performed in only 2.4% of patients, and antimicrobial susceptibility testing in 0.3%. Stock-outs affected 24.3% of antibiotics, with a mean duration of 4.8 days per month. Longer hospital stays, comorbidities, and severe clinical conditions, including sepsis and pneumonia, were associated with increased antibiotic use.