Irrational antibiotic prescriptions in pediatric care across Africa: a systematic review and meta-analysis

Inappropriate antibiotic use, including deviations from guideline recommendations, incorrect dosages, and over-prescription, is a critical public health concern. This systematic review and meta-analysis assessed the prevalence and factors associated with inappropriate antibiotic use in pediatric populations across Africa.

A comprehensive search was conducted in PubMed, Web of Science, and African Journals Online, following PRISMA guidelines and the PICOC framework. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Meta-analysis was performed with STATA 17 using a random-effects model.

From 3,085 records, 11 studies met inclusion. The pooled prevalence of inappropriate antibiotic use was 44%. Rates reached 75.1%, 73.9%, and 71.5% in some countries, while lower rates of 11% and 19.3% were reported elsewhere. Retrospective studies showed a pooled prevalence of 51.2% (I² = 99.5%), and prospective studies 35.4% (I² = 99%). Commonly prescribed antibiotics included cotrimoxazole, amoxicillin, and ceftriaxone. Inappropriate practices involved incorrect dosages (10.1%-19.5%) and durations (17.47-18.8%). Risk factors included younger age, three or more antibiotics (AOR: 2.8, 95% CI: 1.245-6.462, p = 0.013), and prolonged hospitalization.

Inappropriate pediatric antibiotic use in Africa is highly prevalent, driven by age, hospitalization, and polypharmacy, underscoring the need for targeted stewardship interventions.

This study is the first to bring together evidence across Africa showing that nearly half of antibiotics prescribed to children are used inappropriately. The findings call for stronger, targeted antibiotic stewardship efforts to improve prescribing practices and curb the growing threat of resistance in African healthcare settings.