Antibiotic Prescribing Patterns among Healthcare Providers at the University Teaching Hospital Outpatient Department in Lusaka, Zambia, March–April 2025: A Who Aware Classification Study

Background: Antibiotic resistance is a global public health threat driven by irrational antibiotic use. The World Health Organization's Access, Watch, and Reserve (AWaRe) classification guides rational antibiotic use to reduce resistance. This study evaluated antibiotic prescribing patterns at the University Teaching Hospital Outpatient Department in Lusaka, Zambia, using the WHO AWaRe classification.
Methods: A cross-sectional descriptive study was conducted from March to April, 2025. A total of 500 antibiotic prescriptions were retrospectively reviewed, and 187 healthcare providers completed structured questionnaires on prescribing practices and barriers to rational antibiotic use. Data were analysed using SPSS version 20 and Microsoft Excel, with descriptive statistics presented as frequencies and percentages.
Results: Amoxicillin was the most frequently prescribed antibiotic (25.6%), followed by co-amoxiclav (15.0%), ceftriaxone (11.6%), and ciprofloxacin (11.6%). The top four antibiotics accounted for 63.8% of all prescriptions. Overall, 83.8% of prescriptions were appropriate according to the WHO AWaRe classification. Appropriateness was highest for Access antibiotics (87.8%), followed by Watch (77.0%), and lowest for Reserve antibiotics (62.5%). Access antibiotics constituted 65.4% of all prescriptions, exceeding the WHO target of 60%, while Watch and Reserve antibiotics accounted for 33.0% and 1.6%, respectively. Among 187 healthcare providers, 55.1% were male, 40.1% were aged 30–39 years, doctors were the most represented professional group (34.8%), and 44.9% had 1–5 years of experience.
Conclusion: Antibiotic prescribing at UTH OPD is largely appropriate and reasonably aligned with WHO AWaRe recommendations. However, the declining appropriateness from Access to Watch to Reserve antibiotics and the presence of Reserve antibiotics in outpatient settings are concerning. Targeted antimicrobial stewardship interventions, including regular audits, prescriber education, and electronic decision support, are urgently needed to optimize antibiotic use and preserve antibiotic effectiveness

Antibiotic resistance, WHO AWaRe classification, antibiotic prescribing patterns

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