Prevalence and patterns of antibiotic use among inpatients at Muhimbili National Hospital in Tanzania: a WHO Point Prevalence Survey

Objectives To assess the prevalence and patterns of antibiotic use among hospitalized patients, and to characterize prescriptions against the WHO AWaRe classification and national treatment guidelines, to inform antimicrobial stewardship activities. Design Hospital-based descriptive cross-sectional Point Prevalence Survey using the WHO Point Prevalence Survey methodology. Setting Muhimbili National Hospital (MNH), a 1,500-bed national referral and teaching hospital in Dar es Salaam, Tanzania. The hospital was surveyed over three consecutive days (1–3 December 2025) across seven inpatient departments. Participants Of 687 beds screened and 635 eligible inpatients admitted before 08:00 on each survey day, 200 patients were included through systematic random sampling (one in three eligible patients per ward). Primary and secondary outcome measures The primary outcome was the point prevalence of antibiotic use (proportion of surveyed patients receiving ≥1 antibiotic). Secondary outcomes were the indications for use, national guideline compliance, use of microbiological testing, common prescribed agents, and the distribution of prescriptions across WHO AWaRe categories. Results Of 200 patients, 130 (65.0%) were receiving at least one antibiotic. Prescribing was predominantly empirical (92/130, 70.8%); microbiological cultures were obtained for only 17 (13.1%) patients on antibiotics, while guideline compliance was 85.4%. Surgical prophylaxis was the leading indication (45/134, 33.6%), of which 40/45 (88.9%) continued beyond 24 h, followed by community-acquired infections (35/134, 26.1%). Ceftriaxone (25.4%) and metronidazole (23.4%) were the most frequently prescribed agents. Watch-group antibiotics accounted for 52% of prescriptions and Access-group for 48%; no Reserve-group antibiotics were used. Conclusion Antibiotic use was high and characterized by empirical prescribing, limited microbiological guidance, prolonged surgical prophylaxis, and reliance on Watch-group agents. Therefore, strengthening antimicrobial stewardship programs, expanding microbiology diagnostic capacity, and reinforcing adherence to treatment guidelines are urgently needed to optimize antibiotic use and curb antimicrobial resistance in resource-limited settings.