Assessment of Antimicrobial Stewardship practices using process measures in a Nigerian tertiary hospital: a retrospective study

Abstract Objective: To evaluate antibiotic prescribing practices in a Nigerian tertiary hospital using World Health Organization (WHO)-recommended process measures for Antimicrobial Stewardship (AMS). Design: Retrospective cross-sectional study. Patient folders (n = 231) between July 2019 and July 2020 were reviewed using a standardized tool. Relevant data were extracted and analyzed descriptively using SPSS v23, after ethical approval. Setting: Jos University Teaching Hospital (JUTH), a tertiary hospital in Nigeria. Participants: A simple random sample of patients admitted to the male medical wards during the review period. Results: Antibiotics were prescribed in 178 cases (77.1%) but only 149 (64.5%) had a documented indication. Of the patients with no documented indication for antibiotics, 35.3% still received them, often justified as prophylaxis. Ceftriaxone (31.8%) and metronidazole (24.5%) were the most prescribed antibiotics. Correct posology was observed in 77.5% of prescriptions. Adherence to prescribed regimens was low (25.3%), with financial constraints and missed doses being major barriers. Antibiotic time-outs were observed in 34.3% of cases with only 24.7% cases shifting to definitive therapy based on culture results. Empirical therapy accounted for 75.3% of prescriptions. Conclusion: The study revealed suboptimal implementation of AMS principles, characterized by a high reliance on empirical therapy and poor adherence to guideline-based practices. This underscores the urgent need for institutional AMS programs to optimize antibiotic use in similar low- and middle-income country hospital settings.