ANTIMICROBIAL PRESCRIPTION PATTERN AMONG OUTPATIENTS IN GOMBE STATE SPECIALIST HOSPITAL, NIGERIA: PRESCRIBING PRACTICES, PRESCRIBER KNOWLEDGE, AND PREDICTORS OF ANTIBIOTIC USE

Background: Antimicrobial resistance (AMR) is a major public health threat, driven in part by inappropriate and excessive use of antibiotics. Surveillance of antibiotic prescribing practices and assessment of prescriber knowledge are important for identifying opportunities for antimicrobial stewardship, particularly in low- and middle-income countries. This study assessed antimicrobial prescription patterns among outpatients in Gombe State Specialist Hospital, Nigeria, and examined factors associated with antibiotic prescribing and prescriber knowledge of rational antibiotic use and AMR. Methods: A total of 605 outpatient records were randomly assessed alongside information from 31 available prescribers. Patient demographic characteristics, diagnoses, comorbidities, antibiotic prescribing, number and classes of antibiotics, prescription costs, healthcare-seeking behaviour, and use of leftover medicines were assessed. Prescriber characteristics, formal training, diagnostic approaches, awareness of AMR concepts, knowledge of rational antibiotic use and knowledge of AMR causes were also evaluated. Associations between patient characteristics and antibiotic prescription were assessed using chi-square tests and independent-samples t-tests. Logistic regression was used to identify predictors of antibiotic prescribing while adjusting for age, sex, comorbidity count, and selected diagnoses. Results: Antibiotics were prescribed in 49.6% outpatient encounters. Among prescriptions containing antibiotics, the mean number of antibiotics was 1.33 ± 0.55. Generic names were documented in 70.3% of prescriptions. Cephalosporins constituted the largest antibiotic class (29.7%), followed by penicillin (25.0%) and fluoroquinolones (21.0%). The mean antibiotic cost was ₦1,667.82, while the mean total drug cost was ₦3,323.98. Malaria was the most frequent diagnosis (110 cases), followed by hypertension (72) and urinary tract infection (30). Antibiotic prescribing was significantly associated with age, diagnosis, and number of comorbidities. Patients receiving antibiotics were younger than those who did not receive antibiotics (mean age 28.0 versus 37.2 years; p<0.001). In multivariable analysis, increasing age was associated with lower odds of antibiotic prescription (adjusted OR 0.983; 95% CI 0.973–0.992), while malaria was associated with higher odds of antibiotic prescription (OR 1.94; 95% CI 1.03–3.66). Prescribers had a mean awareness score of 62.5%, rational antibiotic-use score of 75.4% and AMR-cause knowledge score of 64.2%. Only 38.7% had received formal training related to antibiotic use/AMR. Conclusion: Antibiotic prescribing occurred in half of the outpatient encounters, with substantial use of cephalosporins, penicillin and fluoroquinolones. Important gaps were identified in prescriber awareness of antimicrobial stewardship and diagnostic tools, while antibiotic prescribing was associated with patient age, diagnosis, and comorbidity profile. Strengthening antimicrobial stewardship, prescriber training, diagnostic capacity, and routine prescription surveillance should be prioritized in outpatient healthcare settings in Gombe State Specialist Hospital.