ANTIBIOTIC PRESCRIBING PATTERNS AND APPROPRIATENESS AMONG PATIENTS WITH COMMUNITY ACQUIRED INFECTIONS ADMITTED TO MEDICAL UNITS AT A TERTIARY CARE HOSPITAL IN ABBOTTABAD PAK

Abstract

Background: Antibiotic prescribing in hospitalized patients with community-acquired infections is an important component of antimicrobial stewardship, particularly in settings where broad-spectrum antibiotics are frequently used and microbiological confirmation is limited. Inappropriate antibiotic selection, dosing, duration, and other prescribing practices may contribute to antimicrobial resistance and unnecessary antibiotic exposure. This study assessed antibiotic prescribing patterns and the appropriateness of antibiotic therapy among adults with community-acquired infections admitted to the medical units of a tertiary care teaching hospital in Abbottabad, Pakistan. Methods: A hospital-based cross-sectional observational study was conducted in the four adult medical units of Ayub Teaching Hospital, Abbottabad, from 5 July 2025 to 5 February 2026. Consecutive adult patients (≥18 years) admitted with a community-acquired infection and receiving systemic antibiotics were included. Data were obtained from medical records, medication charts, clinical notes, laboratory and microbiological reports, and other relevant hospital documentation. Antibiotic prescribing was assessed according to indication, antibiotic selection, dose, frequency, route, and duration, with consideration of the clinical syndrome, severity, patient-related factors, microbiological findings, and WHO AWaRe classification. Empirical therapy was not considered inappropriate solely because microbiological confirmation was unavailable. Descriptive statistics were used to summarize prescribing patterns. Associations between patient or prescribing characteristics and inappropriate antibiotic therapy were assessed using appropriate statistical tests, followed by multivariable logistic regression. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported, and a p-value <0.05 was considered statistically significant. Results: A total of 357 patients were included. The median age was 57 years (IQR 43–69), and 194 (54.3%) were male. At least one major comorbidity was present in 253 (70.9%) patients, while 82 (23.0%) had recent antibiotic exposure. Community-acquired pneumonia was the most common infection syndrome, affecting 142 (39.8%) patients, followed by urinary tract infection in 86 (24.1%) and skin and soft tissue infection in 47 (13.2%). Microbiological investigation was performed in 94 (26.3%) patients, with microbiologically confirmed bacterial infection in 61 (17.1%). Antibiotic therapy was empirical in 296 (82.9%) patients and targeted in 61 (17.1%). Combination antibiotic therapy was prescribed in 200 (56.0%) patients. Intravenous antibiotics alone were used in 235 (65.8%) patients. Third-generation cephalosporins were the most frequently used antibiotic class, prescribed in 192 (53.8%) patients, followed by beta-lactam/beta-lactamase inhibitor combinations in 143 (40.1%). According to the WHO AWaRe classification, Watch antibiotics accounted for 232 (65.0%) principal antibiotic prescriptions, compared with 116 (32.5%) Access and 9 (2.5%) Reserve antibiotics. Overall, antibiotic therapy was classified as appropriate in 121 (33.9%) patients and inappropriate in 236 (66.1%). Among inappropriate prescriptions, the most frequent problems were inappropriate duration in 127 (53.8%) patients and inappropriate antibiotic selection in 109 (46.2%). No valid indication was identified in 74 (31.4%), inappropriate dose in 37 (15.7%), inappropriate route in 31 (13.1%), inappropriate frequency in 29 (12.3%), and failure to modify or de-escalate therapy when indicated in 42 (17.8%). On multivariable analysis, combination antibiotic therapy (adjusted OR 1.78, 95% CI 1.10–2.88; p=0.019), use of a Watch-category principal antibiotic (adjusted OR 1.71, 95% CI 1.05–2.78; p=0.031), and recent antibiotic exposure (adjusted OR 1.84, 95% CI 1.03 3.29; p=0.039) were independently associated with inappropriate prescribing. Conclusion: Inappropriate antibiotic prescribing was common among adults with community-acquired infections admitted to the medical units of Ayub Teaching Hospital, with approximately two-thirds of patients receiving therapy classified as inappropriate according to predefined criteria. Inappropriate treatment duration and antibiotic selection were the most frequent prescribing problems. The findings support strengthening antimicrobial stewardship practices with particular attention to antibiotic selection, documentation and review of treatment duration, reassessment of empirical therapy, and modification or de-escalation when clinically indicated. Locally relevant prescribing guidance, microbiological support, and regular review of antibiotic therapy may help improve the quality and rationality of antibiotic use in the medical units of this tertiary-care hospital.