Patterns of antibiotic use among adult patients across seven hospitals in Malawi: opportunities and challenges for antimicrobial stewardship programmes

Background Antimicrobial resistance (AMR) is one of the top threats to global health, with a disproportionately higher burden in low-and middle-income countries. It is largely driven by excessive and improper use of antibiotics. Optimising antibiotic use has been shown to curb the propagation of AMR. However, this requires data on pre-existing levels and trends of antibiotic use in the healthcare setting that would inform the initiation of appropriate antimicrobial stewardship programmes. Therefore, we carried out this point prevalence survey (PPS) to determine the current patterns of antibiotic use among adult patients across seven facilities in Malawi.We conducted a point prevalence survey using Global Point Prevalence survey forms across three secondary level and four tertiary level hospitals in Malawi between 30 September and 11 October 2024. The survey included all patients who were admitted before 8.00am on the days of data collection, and data were collected on the same day. Adult patient-level antibiotic use data were extracted from medical records using a modified Global point prevalence survey form. Data collected were entered into an Excel sheet and analysed using IBM SPSS version 26 using simple descriptive statistics.Results The survey included a total of 2050 patients across all Hospitals. Overall, antibiotic use was 41.0%, with the highest usage recorded in the Intensive care unit at 62.5%. Ceftriaxone was the most used antibiotic. The highest usage proportion was registered at Mangochi District Hospital (61.5%). The most common indication for antibiotic use was central nervous system infections. Most (74.2%) of the prescriptions were not accompanied by infection biomarkers. However, there was a good self-reported adherence to treatment guidelines.Conclusion The PPS shows rising antibiotic use across AWaRe classes, with more empiric treatments, highlighting the urgent need for antimicrobial stewardship to prevent misuse, resistance, and reduced effectiveness.