DETERMINANTS OF PRESCRIBING ANTIBIOTICS AMONG THE OPD PATIENTS VISITING PUBLIC HOSPITALS

Background: Inappropriate antibiotic prescribing in outpatient departments (OPDs) is a major contributor to antimicrobial resistance, particularly in resource-constrained public hospital settings. The high volume of patients, lack of diagnostics, and systemic pressures often lead to irrational prescribing patterns. Understanding the multifactorial determinants of physician behavior is crucial for designing targeted antibiotic stewardship strategies that are both effective and sustainable. Objective: To assess the prevalence of antibiotic prescribing in OPDs of public hospitals and identify intrinsic and extrinsic factors influencing physicians' prescribing behaviors. Methods: A cross-sectional study was conducted across 8 public hospitals, enrolling 45 OPD physicians selected via stratified cluster sampling. Physicians were eligible if they independently issued at least 100 prescriptions in the prior three months. Prescription audits covering 450 outpatient encounters were analyzed to determine the frequency and nature of antibiotic use. Concurrently, a self-administered questionnaire assessed physicians’ knowledge (via clinical scenarios), attitudes (using a validated scale), and external pressures (measured through Likert-scale items). Descriptive statistics summarized baseline characteristics and prescribing patterns, while multivariate logistic regression identified factors independently associated with antibiotic use. Ethical approval was obtained from the relevant review board, and informed consent was secured from all participants. Results: Antibiotics were prescribed in 54.2% of all OPD visits, with combination antibiotic use recorded in 12.6% of cases. Prescribing rates were higher in rural hospitals (58.7%) compared to urban ones (49.8%). Lower knowledge (OR 1.78; 95% CI: 1.20–2.63; p=0.003) and negative attitudes (OR 1.52; 95% CI: 1.10–2.12; p=0.012) were significantly linked to increased prescribing. High perceived patient demand (OR 1.89; p<0.001), consultation times ≤5 minutes (OR 1.66; p=0.004), and rural practice settings (OR 1.43; p=0.038) were also associated with higher prescription rates. Conclusion: Antibiotic prescribing in public OPDs is driven by a combination of knowledge gaps, attitudinal limitations, patient expectations, time constraints, and setting-specific challenges. Multidimensional interventions addressing both individual and systemic factors are essential to promote rational antibiotic use and reduce the burden of antimicrobial resistance.