Antibiotic prescription patterns and utilization among health insurance patients in a secondary healthcare facility in Nigeria

The World Health Organization (WHO) AWaRe Classification categorizes antibiotics into Access, Watch, and Reserve groups to promote rational use and mitigate antimicrobial resistance. Health insurance beneficiaries constitute a distinct population for investigating antibiotic prescribing patterns due to their access to healthcare services and the availability of comprehensive prescription data. Nevertheless, research has demonstrated that antibiotic prescribing practices among insured populations frequently deviate from recommended guidelines, with over-prescription and inappropriate utilization being most cases. This study aims to assess antibiotic utilization by adopting the WHO AWaRe classification and the defined daily dose (DDD) metric system. This prospective study was conducted at a secondary health facility in Nigeria. Data on antibiotic prevalence were obtained from patients’ medical records. Antibiotic consumption was determined using WHO AWaRe classification and the defined daily dose (DDD) for prescriptions with at least an antibiotic. Multivariable logistic regression analysis was performed to identify the predictors of antibiotic prescription. A p-value less than 0.05 was considered to be statistically significant. Of the prescriptions included in this study, 30.3% contained antibiotics. Age (p = < 0.0001), marital status (p = 0.006), and type of chronic illness (p = 0.0001) were significantly associated with antibiotic prescription. Azithromycin exhibited the highest DDD (1.94/DDD/1000/Day) compared to other antibiotics, while Levofloxacin and Erythromycin were not present on the WHO Essential Medicine List. Furthermore, the Access category (59.5%) was the most frequently prescribed category, with metronidazole (25.6%) being the most commonly prescribed antibiotic. Advanced age (AOR = 3.99; 95% CI = 1.76, 9.03) and female sex (AOR = 1.67; 95% CI = 1.09, 2.56) were associated with increased odds of antibiotic prescription, whereas polypharmacy (AOR = 0.25; 95% CI = 0.17, 0.37) and absence of chronic conditions (AOR = 0.37; 95% CI = 0.21, 0.64) were associated with lower odds of antibiotic prescription. This study did not find any reserve category of antibiotics. Nevertheless, prescriptions within the access category were observed to be more prevalent among female participants while azithromycin, classified as a watch category antibiotic, demonstrated the highest consumption pattern.