# Prevalence and patterns of antibiotic prescriptions in Conakry hospitals, Guinea: a multicentre cross-sectional survey

## TL;DR

This study found high rates of antibiotic prescriptions in hospitals in Conakry, Guinea, with most given without testing, highlighting the need for better antibiotic stewardship.

## Contribution

The study provides the first detailed assessment of antibiotic prescription patterns in Conakry hospitals using WHO AWaRe classification.

## Key findings

- Overall antibiotic prescription prevalence was 35.0%, with inpatients having much higher rates than outpatients.
- Most prescriptions were beta-lactams and third-generation cephalosporins, and nearly all were given empirically without testing.
- 64.3% of antibiotics belonged to the WHO Access group, and 33.3% to the Watch group.

## Abstract

Inappropriate use of antibiotics is a major driver of antimicrobial resistance (AMR), particularly in low- and middle-income countries. Understanding antibiotic use and patterns in hospital settings is essential for promoting rational use and optimizing antimicrobial stewardship (AMS). This study aims to assess the extent of antibiotic prescribing in secondary and tertiary hospitals in Conakry, Guinea, and to evaluate the appropriateness of these prescriptions on the basis of WHO recommendations via the Access, Watch, Reserve (AWaRe) classification of antibiotics.

A multicentre cross-sectional survey was conducted from June to October 2024 to assess patient antibiotic use levels across six hospital wards in Conakry, capital of Guinea. The prevalence of antibiotic prescriptions, with 95% confidence intervals (CI), was compared across patient, prescriber and ward variables. Antibiotic use was categorized by Anatomic Therapeutic Chemical and AWaRe classifications. Associations between categorical variables were assessed using the Chi-square or Fisher's exact test. Univariate and multivariate logistic regression were used to analyse factors associated with antibiotic prescription.

Of 1482 patients surveyed, the overall prevalence of antibiotic prescriptions was 35.0% (95% CI: 32.6–37.5), with significant differences between inpatients (83.4%, 95% CI: 78.1–87.6) and outpatients (25.1%, 95% CI: 22.7–27.6). The total number of antibiotics prescribed was 669, and the most commonly prescribed antibiotics were beta-lactams/beta-lactamase inhibitors (24.2%), followed by third-generation cephalosporins (21.7%), imidazoles (18.5%), and penicillins (13.6%). Almost all antibiotic courses (99.4%) were started empirically, without microbiological testing to guide choice. Regarding the AWaRe classification of all prescribed antibiotics, Access antibiotics accounted for 64.3% (430/669), and 33.3% (223/669) were from the Watch group.

The results of this study, conducted in six hospital departments, provide an overview of antibiotic prescriptions in Conakry hospitals, with a high prevalence of antibiotic prescription, particularly among inpatients and almost all courses were initiated empirically without microbiological guidance. These findings underscore the urgent need for AMS programs and interventions.