Antibiotic utilisation trends and prescribing-associated factors at a regional hospital in Ghana: an eight-year retrospective study with a prescriber survey

Abstract

Inappropriate antibiotic use is a key driver of antimicrobial resistance (AMR), a growing global public health threat. Monitoring prescribing patterns using standardised metrics such as World Health Organisation (WHO) prescribing indicators and Defined Daily Dose (DDD) supports antimicrobial stewardship. Evidence on outpatient antibiotic prescribing in parts of Ghana remains limited. This study assessed antibiotic prescribing trends and associated prescriber factors at a regional hospital in Ghana. A hospital-based observational study was conducted at Bono Regional Hospital, Sunyani. Retrospective outpatient antibiotic prescription data (January 2014–December 2021) were extracted from the Hospital Administration Management Software. Antibiotic utilisation was quantified using DDD per 1,000 inhabitants per day. The study employed a cross-sectional survey of prescriber characteristics that were associated with antibiotic prescribing practices. Descriptive statistics summarised prescribing patterns. Associations were examined using chi-square tests and binary logistic regression at p < 0.05. A total of 1,014,368 outpatient antibiotic prescription records were analysed. Antibiotic consumption increased from 1.87 DDD/1,000 inhabitants/day in 2014 to 11.23 DDD/1,000 inhabitants/day in 2021, with a temporary decline in 2020. Among all antibiotic prescription records, amoxicillin/clavulanic acid was the most frequently prescribed antibiotic (146,924; 14.39%), followed by erythromycin (116,816; 11.44%), ciprofloxacin (116,003; 11.36%), and amoxicillin (110,527; 10.83%). Five antibiotics accounted for more than half of total prescriptions. Among 35 prescribers (response rate: 64.8%), age and years of practice were associated with prescribing in bivariate analysis but were not significant in multivariable models. Delayed laboratory results were the most frequently reported barrier to rational prescribing. Outpatient antibiotic prescribing increased over time with substantial reliance on broad-spectrum agents. There is a need for better management of healthcare resources and enhanced diagnostic facilities, which will help achieve proper antibiotic usage and control antimicrobial resistance.