Global antibiotic prescription practices in hospitals and associated factors: a systematic review and meta-analysis

The prevalence of antibiotic prescribing among total prescriptions, the percentage of combined antibiotic prescribing among prescriptions containing at least one antibiotic, and factors influencing hospital antibiotic prescribing are currently unknown. In this systematic review, we aimed to summarise antibiotic prescribing in hospitals worldwide and identify the associated factors.

We searched PubMed/MEDLINE, Ovid/Embase, and the Web of Science for articles published between 1 January 2000 and 28 February 2023 that reported antibiotic prescribing in hospitals or the associated factors. Four reviewers independently screened studies, extracted data, and assessed the risk of bias. We used meta-analysis with random-effects models to estimate the pooled effect sizes.

We included 403 studies covering 93 economies. The pooled prevalence of antibiotic prescribing among total prescriptions was 34.3% (95% CI = 29.6-39.3) in outpatient settings and 47.7% (95% CI = 45.8-49.5) in inpatient settings. The pooled percentages of antibiotics in the 'access' group were 48.5% (95% CI = 34.5-62.7) in outpatient settings and 43.8% (95% CI = 39.2-48.5) in inpatient settings. Subgroup analysis showed the prevalence of antibiotic prescribing was significantly higher in low-income compared to high-income economies. Additionally, there was a rising trend of the prevalence in inpatient settings over time. The studies showed that patients' gender, education level, health status, and physicians' work experience were associated with hospital antibiotic prescribing.

The global prevalence of antibiotic prescribing in hospitals is high, with significant disparities across regions. Multifaceted measures with multi-sectoral cooperation are required, such as regulatory interventions, professional training for physicians, and public health education.

PROSPERO: CRD42022354076.