Antibiotics Use Patterns in Low- and Middle-Income Countries: A Systematic Review Analysis

Area of Science:

• Global Health
• Infectious Diseases
• Pharmacology

Background:

• Antibiotic resistance is a significant global health challenge driven by inappropriate antibiotic use.
• Rational antibiotic use is crucial for effective infection treatment and mitigating resistance.
• Low- and middle-income countries face unique challenges in antibiotic prescribing patterns.

Purpose of the Study:

• To systematically review antibiotic use patterns in low- and middle-income countries.
• To assess antibiotic prescribing against World Health Organization (WHO) standards.
• To inform interventions promoting rational antibiotic use and reducing resistance.

Main Methods:

• Systematic review following PRISMA guidelines.
• Searched Scopus, Embase, and Medline databases (Jan 2010 - Nov 2025).
• Included 20 cross-sectional studies from 11 countries, assessed using Kmet Critical Appraisal Checklist.

Main Results:

• Average "percentage of prescriptions with antibiotics" was 51.4% (52.7% private, 49.3% public sector).
• High use of "Watch" antibiotics (47.4%-74.0%) exceeded WHO recommendations in some studies.
• Amoxicillin was most frequent; however, "Watch" antibiotics were also widely prescribed.

Conclusions:

• Antibiotic prescription rates and the use of "Watch" antibiotics often exceed WHO recommendations in reviewed settings.
• Implementing effective antibiotic stewardship programs is essential.
• Interventions are needed to promote rational antibiotic use and combat resistance in these regions.