Rational Use of Antibiotics among inpatients at a University Teaching Hospital of Butare, in Rwanda: A Cross-Sectional Study

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Abstract Background Irrational use of antibiotics is a major factor in antibiotic resistance and poor patient outcomes. Globally, 50% of antibiotics are prescribed inappropriately, in Sub-Saharan Africa alone, antimicrobial resistance was linked to approximately 1.27 million deaths in 2019, mainly due to the misuse and overuse of antibiotics. In this study, we collected data to understand the prescribing patterns and factors associated with irrational antibiotic use among hospitalized patients. Methodology A hospital-based observational cross-sectional study was conducted between October and December 2024 among 655 patients. The study was conducted at a University Teaching Hospital in Rwanda. Results Among 655 inpatients, 1,265 antibiotics were prescribed, equivalent to 1.95 per patient. Out of 1463 inpatients in the hospital, 44.76% received at least one antibiotic. The most prescribed antibiotics were Ceftriaxone (34.6%), followed by Flagyl (20%). The majority of antibiotics (83%) were prescribed in injectable forms. Culture and antibiogram testing were performed in 23.20% of cases, this was associated with deviation from national Standard Treatment Guidelines (STGs) adherence (Adjusted OR = 0.07, CI: 0.03-0.14, p = 0.001). there is a significant likelihood of non-adherence to STGs in internal medicine (Adjusted OR=0.25, CI: 0.10-0.62, p = 0.003) and pediatrics (Adjusted OR=0.33, CI: 0.16-0.67, p = 0.002). Conclusion In this study, we found improper use of antibiotics, deviating from WHO-endorsed standards and a high empiric prescription of antibiotics. Deviation from national STGs was highly associated with empirical prescription. Improving adherence to diagnostic support and antimicrobial stewardship programs could address the problem.

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