Comprehensive review of antibiotic prescription practices, overuse, misuse, and resistance trends in Al Muthanna, Iraq

Background: Antibiotic resistance is a global health concern exacerbated by the overuse and misuse of antibiotics. This retrospective study aims to investigate the clinical trends of antibiotic use and its overuse and misuse rates in two hospitals and community pharmacies in Al Muthanna, Iraq, with a focus on adherence to WHO guidelines. Methods: Medical records from two main hospitals in Al Muthanna, Iraq, were obtained from the Health Information System in 2023-2024. Additionally, data on antibiotic sales without prescriptions were collected from community pharmacies. Classification of antibiotic use was performed based on WHO guidelines. Results: A total of 5700 antibiotic prescriptions were retrieved from hospitals, and an additional 2,000 antibiotic sales without prescriptions were recorded from pharmacies. Uncomplicated respiratory infections were the most prevalent condition, representing 60% of all hospital prescriptions. The primary group of antibiotics used was penicillin (50%), followed by cephalosporins (20%) and macrolides (15%). Of 4,000 patient visits in hospitals, appropriate use accounted for 20% of all antibiotic prescriptions. While combined use, escalated use of extended-spectrum antibiotics, incorrect spectrum, and unnecessary antibiotic use were prevalent. In community pharmacies, 90% of antibiotics were sold without a prescription, with penicillins and cephalosporins being the most commonly dispensed. Antibiotic misuse was much more common among newly employed physicians with lower levels of professional education. Adult patients had a higher risk of being prescribed unnecessary antibiotics. Conclusion: Adherence to WHO guidelines for antibiotic prescribing and dispensing needs urgent attention to mitigate the growing threat of antibiotic resistance.