Unveiling and Assessing Antibiotic Misuse in Saudi Arabia—A Systematic Review and Meta-Analysis

Background: Antibiotic misuse and prescribing errors are significant concerns in clinical practice, contributing to unnecessary antibiotic exposure, increased adverse effects, rising healthcare costs, and the escalation of antibiotic resistance. Understanding the prevalence, patterns, and risk factors of these prescription errors is essential for improving patient safety and healthcare efficiency in the future. Aim: Our aim was to evaluate the prevalence, patterns, and risk factors of antibiotic prescription errors in Saudi Arabia. Methods: A comprehensive search of three databases (PubMed, Scopus and ProQuest) was conducted to identify eligible cohort and cross-sectional studies in Saudi Arabia published up to January 2025. Studies that reported on error rates of antibiotic prescription errors and those that did not provide quantitative data were excluded. The primary outcome was the prevalence and patterns of inappropriate antibiotic use, while the secondary outcomes included the pooled prevalence of specific errors (i.e., selection, dose, duration, etc.). The quality of the studies was assessed using the Newcastle–Ottawa scale. This review was registered in PROSPERO (CRD42024611747). Results: Fourteen eligible cohort (n = 2) and cross-sectional (n = 12) studies conducted in Saudi Arabia were included in the review. Two studies reviewed medical records and orders of patients. Patient selection varied from emergency department to intensive care units and outpatients. The pooled prevalence of antibiotic prescription errors was 42.7% [95% CI: 37.5–47.8], with common errors including dosage (29.3%), duration (24.3%), selection (15%) and frequency (11.1%) errors. However, there was a high heterogeneity among the results. Overall, the quality assessment revealed a low risk of bias, except for one study with a high risk of bias. Conclusion: These findings highlight the high prevalence of antibiotic prescription errors. Future efforts should strengthen antibiotic stewardship, enhance clinician training, and ensure adherence to evidence-based guidelines to reduce prescription errors and combat antibiotic resistance.