Inappropriate antibiotic utilization in hospitalized patients in Ethiopia: A systematic review and meta-analysis

Inappropriate antibiotic use is a major driver of antimicrobial resistance and adverse clinical outcomes. Evidence on its pooled prevalence and determinants among hospitalized patients in Ethiopia remains scarce. Therefore, this study aimed to estimate the pooled prevalence of inappropriate antibiotic use and associated factors among hospitalized patients in Ethiopia.

This systematic review and meta-analysis was reported in accordance with the PRISMA statement and registered in PROSPERO (CRD420261379594). A comprehensive literature search was conducted from December 5 and December 19, 2025. Electronic databases including PubMed/MEDLINE, Embase, ScienceDirect, Scopus, and PsycINFO were systematically searched. In addition, supplementary platforms and grey literature sources including Google Scholar, ResearchGate, and HINARI were explored to identify relevant studies. Data were extracted using Microsoft Excel and analyzed using Stata version 14.0. A random-effects model was employed to estimate the pooled prevalence, and heterogeneity was assessed using the I² statistic. Subgroup analysis, sensitivity analysis, and assessment of publication bias were also performed.

Twelve primary studies were included. The pooled prevalence of inappropriate antibiotic use among hospitalized patients in Ethiopia was estimated at 40.50% (95% CI: 24.88-56.16). However, this estimate should be interpreted with caution due to the very high heterogeneity observed across studies (I² = 99.5%). Inappropriate indication (26.2%) and incorrect duration of therapy (24.65%) were the most common forms of inappropriateness. Comorbid conditions (OR = 3.46; 95% CI: 2.79-4.28) and multiple medication co-prescription (OR = 2.98; 95% CI: 2.31-3.84) were significantly associated. The pooled prevalence of antibiotic utilization among hospitalized patients was 59.42% (95% CI: 48.76-70.07). Empirical therapy accounted for 93.26% of prescriptions, while culture and sensitivity testing was performed in only 17.7% of cases. The mean number of antibiotics prescribed per patient was 1.95. Metronidazole, cephalosporin, and penicillin were the most commonly prescribed antibiotics.

Inappropriate antibiotic use among hospitalized patients in Ethiopia appears to be high and may be associated with empirical prescribing, limited diagnostic confirmation, comorbidities, and polypharmacy. Strengthening antimicrobial stewardship, and adherence to treatment guidelines is urgently needed.