Authors: Abdulmohsen Mahdi Alanazi , Ibrahim Mofarih Assiri , Fawaz Thamer Alsalamh , Khalid Obeed Alanizy , Talal Salem Alanazi

Abstract

Background: Evaluating antibiotic prescribing patterns is important to enhancing patient safety and healthcare quality. According to the World Health Organization (WHO), antibiotics are the most commonly prescribed medication in emergency departments (EDs), where 20%-50% of prescribed antibiotics are unnecessary and contribute to antimicrobial resistance (AMR). AMR is directly responsible for 1.27 million deaths worldwide annually. Increasing prevalence of AMR in Saudi Arabia underscores the urgent need to assess antibiotic utilization.

Objective: To assess antibiotic prescribing patterns at the ED of Care Medical Al-Malaz (CMM) using the WHO/ International Network of Rational Use of Drugs (INRUD) indicators, compare them with the WHO benchmark data, and support antimicrobial stewardship improvements.

Methods: A retrospective cross-sectional study analyzed adult ED antibiotic prescriptions at CMM (October- December 2024). The WHO/INRUD prescribing indicators were used to evaluate trends in antibiotic patterns. Key metrics included average drugs per encounter, generic prescribing, and rates of antibiotic and injection use.

Results: This retrospective study analyzed 14,893 ED encounters, identifying 2,775 eligible prescriptions with 3,251 antibiotics. Oral antibiotics were prescribed (73.2%), and Watch-antibiotic agents (67.3%) predominated, mainly macrolides (30.4%) and cephalosporins (28.3%). The average number of drugs per encounter (3.9) and antibiotics prescribed in 32.0% exceeded the WHO standards. Generic prescribing (100%) and injection rates (20.9%) met the standard, and essential drug compliance was 99.56%. Culture testing was performed in only 59 cases with over 2,775 patients.

Conclusion: Antibiotic prescribing at the ED of CMM exceeds the WHO guidelines, driven by high polypharmacy, irrational antibiotic use, reliance on Watch-group antibiotics, and higher empirical treatment with limited diagnostic testing. These findings underscore the urgent need to enhance antimicrobial stewardship and prescribing practices.

Keywords: Antibiotic Prescribing Patterns, Antimicrobial Resistance (AMR), Emergency Department (ED), WHO/INRUD Indicators, Antimicrobial Stewardship, Saudi Arabia.