Evaluation of antibiotic use among neonates admitted in Kawempe National Referral Hospital

Abstract

Introduction: Antibiotics are frequently used to treat bacterial infections in neonatal units, but studies in Africa show inappropriate prescribing practices, especially in underdeveloped countries. Neonatal mortality accounts for 57% of global infant deaths and 40% of under-5 mortality. The irrational use of antibiotics can lead to treatment failures, antibiotic resistance, and increased healthcare costs. In Uganda, healthcare professionals often prescribe systemic antibiotics without confirmed diagnoses, risking inadequate treatment and higher morbidity and mortality rates. Objective: To evaluate antibiotic use among neonates admitted to Kawempe National Referral Hospital Methods: We carried out a cross-sectional study using retrospective data from patient files of neonates admitted in Kawempe National Referral Hospital from August 2024 to the January 2025. A total of 323 antibiotic prescriptions were reviewed using a structured tool adapted from Uganda's National Antimicrobial Guidelines. The data was then analyzed using Microsoft Excel and Stata to evaluate the use of antibiotics among neonates. Results: Antibiotic use prevalence was 100%. A total of 323 prescriptions had antibiotics prescribed, with gentamicin (38.9%) and ampicillin (34.8%) being the most frequently used. Access category antibiotics accounted for 70.98% of prescriptions, followed by Watch (28.89%) and Reserve (0.14%). Adherence to treatment guidelines varied with the lowest being for dose (52.82%), followed by duration (84.9%) and lastly frequency (89.4%). Only 65.3% of prescriptions were based on laboratory-confirmed diagnoses. The leading indication for antibiotics was low birth weight with 40.56%. Conclusion: Antibiotic prescribing among neonates was high, with predominant use of Access antibiotics aligning with WHO recommendations. However, suboptimal adherence to dosing guidelines indicates a need for strengthened prescribing practices. Variability in guideline use and limited diagnostic support highlight the need for standardized neonatal protocols, and enhanced antimicrobial stewardship to mitigate AMR risks.