Assessment of Antibiotic Prescribing Patterns in a District General Hospital in Bangladesh using WHO Prescribing Indicators

Background: Antimicrobial resistance is among the leading causes of death worldwide, and antibiotic consumption is its principal modifiable driver. Standardised, facility-level prescribing data from district-level hospitals in Bangladesh are scarce. Objective: To assess the pattern of antibiotic prescribing among inpatients of a district general hospital in Bangladesh using WHO prescribing indicators. Materials and Methods: A prospective cross-sectional study was conducted at the 250-Bedded General Hospital, Naogaon, Bangladesh, from January to April 2025. One hundred inpatients prescribed at least one antibiotic were enrolled by purposive sampling. Data on prescriptions, documented indications, and microbiological culture and susceptibility results were collected using a structured form and analysed descriptively using SPSS version 20.0. Results: Sixty-four patients (64%) were male and the mean age was 43.28 (SD 27.46) years. The mean number of medicines per encounter was 5.92 (SD 1.197), against a WHO optimal value of 1.6–1.8. The mean number of antibiotics per patient was 1.72 (SD 0.665), and 59 patients (59%) received two or more antibiotics. Antibiotics were administered intravenously in 96 patients (96%) for a mean of 7.8 (SD 1.45) days. No indication was documented in 37 patients (37%), and surgical prophylaxis was the most frequent documented indication (18%). Specimens were submitted for culture in 48 patients (48%), of which 39 (81.25%) yielded growth, most frequently Streptococcus pyogenes (20.83%), Escherichia coli (18.75%) and Staphylococcus aureus (16.67%). Among 42 isolates tested, resistance exceeded 50% for flucloxacillin (59.52%), ciprofloxacin and ceftriaxone (54.76% each), and cefuroxime and gentamicin (52.38% each); linezolid (97.62%) and moxifloxacin (95.24%) retained susceptibility. Conclusion: Prescribing volume exceeded WHO reference values, more than one-third of antibiotic prescriptions carried no documented indication, culture-directed prescribing was uncommon, and resistance to several agents in routine empirical use exceeded 50%.