Antimicrobial use, prescribing quality, and therapy-related problems among hospitalized patients in Northeast Ethiopia – Nature .Com

Scientific Reports , Article number:  (2025) Cite this article

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Abstract

Background

Antimicrobials are the leading drug class implicated in drug therapy problems (DTPs). In Ethiopia, comprehensive evidence on antimicrobial-related DTPs in high-risk hospital settings such as medical, surgical, and intensive care units (ICUs) is limited. Inappropriate prescribing in these wards can lead to serious clinical consequences. This study assessed the prevalence of antimicrobial-related DTPs, predictors, and prescribing quality of antimicrobials among hospitalized adult patients in Northeast Ethiopia.

Methods

This study employed a hospital-based cross-sectional design with prospective data collection from August 12 to October 30, 2024, at Dessie and Woldia Comprehensive Specialized Hospitals. A total of 334 adult inpatients were consecutively and proportionally enrolled. Data were collected using structured checklists, patient interviews, and medical record reviews. Epi Info version 7.2 and SPSS version 27 were used for data entry and analysis. Descriptive statistics summarized patient characteristics and antimicrobial use. Logistic regression identified predictors of antimicrobial-related DTPs, with statistical significance set at p < 0.05.

Results

This study was conducted in two hospitals and involved a total of 334 patients, of whom 65% were male. Overall, 83.5% experienced at least one antimicrobial-related DTP. The most frequent was a subtherapeutic dose (72.8%), while ineffective antimicrobial therapy was the least common (5.4%). Safety and adherence-related problems each affected 23.4% and 70.4% of patients, respectively; effectiveness-related issues occurred in 75.4%, and indication-related problems in 74.3%. Binary logistic regression analysis identified independent predictors of antimicrobial-related DTPs, including use of 3–6 medications (AOR = 8.39, 95% CI: 3.53–18.41, p < 0.001), use of ≥6 medications (AOR = 3.49, 95% CI: 1.32–9.23, p = 0.01), and care provided by Intern (AOR = 4.39, 95% CI: 1.27–15.15, p = 0.02). Documentation of antimicrobial prescribing was frequently incomplete: treatment duration was absent in 99.4% of cases, prophylactic indications in 84.1%, and stop/review dates in 53.0%.

Conclusion

Antimicrobial-related DTPs were common among hospitalized adults in Northeast Ethiopia. Polypharmacy and prescriber qualification were identified as key contributing factors. These findings underscore the need to strengthen antimicrobial stewardship initiatives and promote rational prescribing practices to mitigate DTPs and enhance patient safety.

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Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

ADRs:

Adverse drug reactionsAMR:

Antimicrobial resistanceAOR:

Adjusted odds ratioBMH:

Boru meda general hospitalCI:

Confidence intervalCOR:

Crude odds ratioDCSH:

Dessie comprehensive specialized hospitalsDTPs:

Drug therapy problemsICUs:

Intensive care unitsWCSH:

Woldia Comprehensive Specialized HospitalWHO:

World Health Organization

References

  1. Cipolle, R.J., SLaMP. Drug Therapy Problems. In: The Patient-Centered Approach to Medication Management Services. New York, United States: McGraw Hill. (2023).
  2. van Mil, J. W., Westerlund, L. O., Hersberger, K. E. & Schaefer, M. A. Drug-related problem classification systems. Ann. Pharmacother. 38(5), 859–67 (2004).Google Scholar 
  3. Belayneh, Y. M., Amberbir, G. & Agalu, A. A prospective observational study of drug therapy problems in medical ward of a referral hospital in northeast Ethiopia. BMC Health Serv. Res. 18(1), 808 (2018).Google Scholar 
  4. Hale, C. M., Steele, J. M., Seabury, R. W. & Miller, C. D. Characterization of drug-related problems occurring in patients receiv ing outpatient antimicrobial therapy. J. Pharm. Pract. 30(6), 600–5 (2017).Google Scholar 
  5. Heijden, M. et al. When the drugs don’t work antibiotic resistance as a global developmen t problem 2020 (Uppsala, 2019).Google Scholar 
  6. Jamaluddin, N. A. H. et al. Assessment of antimicrobial prescribing patterns, guidelines compliance, and appropriateness of antimicrobial prescribing in surgical-practice units: Point prevalence survey in Malaysian teaching hospitals. Front. Pharmacol. 15, 1381843 (2024).Google Scholar 
  7. Retamar, P., Martín, M. L., Molina, J. & del Arco, A. Evaluating the quality of antimicrobial prescribing: Is standardisation possible?. Enfermedades Infecciosasy Microbiol. Clín. 31, 25–30 (2013).Google Scholar 
  8. Murray, C. J. et al. Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. Lancet 399(10325), 629–55 (2022).Google Scholar 
  9. Naghavi, M. et al. Global burden of bacterial antimicrobial resistance 1990–2021: A systematic analysis with forecasts to 2050. Lancet 404(10459), 1199–226 (2024).Google Scholar 
  10. Sartorius, B. et al. The burden of bacterial antimicrobial resistance in the WHO African region in 2019: A cross-country systematic analysis. Lancet Global Health 12(2), e201–e16 (2024).Google Scholar 
  11. Cotton, C.M. Antibiotic Stewardship. Neonatology Questions and Controversies: Infectious Disease, Immunology, and Pharmacology. (2023):43.
  12. Limato, R. et al. A multicentre point prevalence survey of patterns and quality of antibiotic prescribing in Indonesian hospitals. JAC-antimicrobial Resistance 3(2), dlab047 (2021).Google Scholar 
  13. Organization WH. Medication without harm: policy brief: World Health Organization; (2024)
  14. Fentie, A. M. et al. Multicentre point-prevalence survey of antibiotic use and healthcare-associated infections in Ethiopian hospitals. BMJ Open 12(2), e054541 (2022).Google Scholar 
  15. Adem, F. et al. Drug-related problems and associated factors in Ethiopia: A systematic review and meta-analysis. J. Pharm. Policy Pract. 14(1), 36 (2021).Google Scholar 
  16. Bekele, N. A. & Hirbu, J. T. Drug therapy problems and predictors among patients admitted to medical wards of dilla university referral hospital, South Ethiopia: A case of antimicrobials. Infect. Drug Resist. 13, 1743–50 (2020).Google Scholar 
  17. World Health O. Medication Safety in Polypharmacy. (2019)
  18. American Society of Health-System Pharmacists. ASHP guidelines on preventing medication errors in hospitals. Am. J. Health Syst. Pharm. 75, 1493–517 (2018).Google Scholar 
  19. WHO. Medication without harm: policy brief: World Health Organization; (2024).
  20. Yadesa, T. M. Inappropriate use of antimicrobials and the determinants among patients hospitalized in 3 hospitals (Mizan, Bonga and Tepi) in Southwest Ethiopia. J. Bioanal. Biomed. 09(01), 45 (2017).Google Scholar 
  21. Ceyhan, M. et al. Inappropriate antimicrobial use in Turkish pediatric hospitals: A mult icenter point prevalence survey. Int. J. Infect. Dis. IJID: Off. Publ. Int. Soc. Infect. Dis. 14(1), e55-61 (2010).Google Scholar 
  22. Peterson, C. & Gustafsson, M. Characterisation of drug-related problems and associated factors at a clinical pharmacist service-naïve hospital in Northern Sweden. Drugs Real World Outcomes 4(2), 97–107 (2017).Google Scholar 
  23. Klein, E. Y., Tseng, K. K., Pant, S. & Laxminarayan, R. Tracking global trends in the effectiveness of antibiotic therapy usin g the Drug Resistance Index. BMJ Global Health 4(2), 12 (2019).Google Scholar 
  24. Tefera, G. M., Feyisa, B. B. & Kebede, T. M. Antimicrobial use–related problems and their costs in surgery ward of Jimma University Medical Center: Prospective observational study. PLOS One. 14(5), e0216770 (2019).Google Scholar 
  25. Babirye, M., Yadesa, T. M., Tamukong, R. & Obwoya, P. S. Prevalence and factors associated with drug therapy problems among hypertensive patients at hypertension clinic of Mbarara Regional Referral Hospital, Uganda: A |cross-sectional study. Ther Adv Cardiovasc Dis 17, 17539447231160320 (2023).Google Scholar 
  26. Corsonello, A. et al. The impact of drug interactions and polypharmacy on antimicrobial ther apy in the elderly. Clin. Microbiol. Inf. Off. Publ. Eur. Soc. Clin. Microbiol. Infect. Dis. 21(1), 20–6 (2015).Google Scholar 
  27. Daunt, R., Curtin, D. & O’Mahony, D. Optimizing drug therapy for older adults: Shifting away from problematic polypharmacy. Expert Opin. Pharmacother. 25(9), 1199–208 (2024).Google Scholar 
  28. Faulkner, C. M., Cox, H. L. & Williamson, J. C. Unique aspects of antimicrobial use in older adults. Clin. Infect. Dis. 40(7), 997–1004 (2005).Google Scholar 
  29. Takele B, Koyra HC, Sidamo T, Lerango TL. Tripled likelihood: polypharmacy increases the occurrence of drug ther apy problems in hospitalized pediatric patients. Frontiers in Pharmacology. (2024) 15
  30. Gwimile, J. J., Shekalaghe, S. A., Kapanda, G. N. & Kisanga, E. R. Antibiotic prescribing practice in management of cough and/or diarrhoea in Moshi Municipality, Northern Tanzania: cross-sectional descriptive study. Pan African Med. J. 12, 103 (2012).Google Scholar 
  31. Hulscher, M. E., van der Meer, J. W. & Grol, R. P. Antibiotic use: How to improve it?. Int. J. Med. Microbiol. 300(6), 351–6 (2010).Google Scholar 
  32. Magill, S. S. et al. Assessment of the appropriateness of antimicrobial use in US hospitals. JAMA Netw. Open. 4(3), e212007 (2021).Google Scholar 
  33. Spernovasilis, N. et al. Antimicrobial prescribing before and after the implementation of a Car bapenem-focused antimicrobial stewardship program in a greek tertiary hospital during the COVID-19 pandemic. Antibiotics 12(1), 39 (2022).Google Scholar 

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Acknowledgments

We would like to extend our sincere gratitude to the data collectors for their immense support throughout the study period and the hospital staff for their cooperation in the data collection process.

Funding

The authors received no specific funding for this work.

Author information

Authors and Affiliations

  1. Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, EthiopiaMengistie Yirsaw Gobezie, Seble Zewdu, Nuhamin Alemayehu Tesfaye, Minimize Hassen & Abebe Zeleke Belay

Contributions

M.Y, S.Z. and A.Z. conceptualized and designed the study, wrote the original manuscript, and analyzed and interpreted the data. M.H and N.A assisted with the validation of the data instruments, study design, and manuscript evaluation. All authors have made intellectual contributions to the work and approved the final version of the manuscript for submission.

Corresponding author

Correspondence to Mengistie Yirsaw Gobezie.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

Ethical clearance was obtained from the Research Ethics Review Committee of the College of Medicine and Health Sciences, Wollo University (Ref. No. CMHS/RE/203/2024, dated August 12, 2024). The committee waived written informed consent as the study involved minimal risk and record review; verbal consent was obtained from patients during supplementary interviews. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.

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Gobezie, M.Y., Zewdu, S., Tesfaye, N.A. et al. Antimicrobial use, prescribing quality, and therapy-related problems among hospitalized patients in Northeast Ethiopia. Sci Rep (2025). https://doi.org/10.1038/s41598-025-30634-w

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