Prevalence, patterns, and predictors of outpatient antibiotic prescribing in Saudi Arabia: an observational study

Inappropriate antibiotic use in outpatient settings is a key driver of antimicrobial resistance globally. In Saudi Arabia, real-world population-level evidence on outpatient antibiotic prescribing remains limited. This study aimed to determine the prevalence, describe the prescribing patterns, and identify predictors of outpatient antibiotic prescribing using national electronic prescription data. This retrospective population-based study analyzed outpatient prescriptions issued through the Wasfaty system between January 2023 and December 2024 in Taif and surrounding governorates in the Makkah region. Descriptive analyses characterized prescribing patterns, while temporal trends were assessed using monthly and quarterly aggregation. Logistic regression identified demographic and regional predictors of antibiotic use. Among 731,755 patients, 416,776 (57.0%) received at least one antibiotic during the study period, and 880,064 of 7,351,813 outpatient prescriptions (12.0%) included an antibiotic. Prescribing varied by region, with higher prevalence in Ranyah (74.6%; aOR 2.42, 95% CI 2.38–2.47) and Turubah (70.5%; aOR 1.98, 95% CI 1.93–2.04) compared with Taif. Toddlers (64.1%; aOR 1.45, 95% CI 1.42–1.47) and school-age children (65.4%; aOR 1.56, 95% CI 1.54–1.57) had the highest odds, while infants (aOR 0.51, 95% CI 0.50–0.52) and elderly patients (aOR 0.71, 95% CI 0.70–0.73) had lower odds. Amoxicillin, amoxicillin/clavulanic acid, and azithromycin accounted for 75.3% of prescriptions. Prescribing peaked during the first and fourth quarters. Outpatient antibiotic use remains substantial in Saudi Arabia, with marked demographic, geographic, and seasonal variation. These findings highlight priority areas for targeted antimicrobial stewardship and demonstrate the value of national electronic prescribing data for surveillance and policy planning.