{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T21:06:05Z","timestamp":1791839165160,"version":"4.3.4"},"reference-count":28,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"unspecified","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"UK Department of Health and Social Care -Fleming Fund"},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["226692\/Z\/22\/Z"],"award-info":[{"award-number":["226692\/Z\/22\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,2,12]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Limited data exist on temporal changes in antibiotic use in low and middle-income countries. We evaluated trends in antibiotic use at tertiary hospitals in Uganda.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective trend analysis of a repeated point prevalence survey (PPS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and participants<\/jats:title>\n                    <jats:p>This study utilised antibiotic use data from quarterly PPS conducted among inpatients at nine regional referral hospitals in Uganda between October 2020 and December 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>\n                      We determined the proportions of antibiotic use, prescriptions guided by culture and sensitivity tests (CST), WHO AWaRe (\n                      <jats:italic>Access, Watch and Reserve<\/jats:italic>\n                      ) categories, and prescriptions without documented indication. Linear regression was used to derive slope coefficients and 95% confidence interval (CI).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 15,154 patients surveyed, 8,892 (58.7%) received systemic antibiotics. The median age was 23 years (IQR: 11\u201338), 5,338 (60.5%) were female, and 4,583 (51.5%) were on treatment for infectious syndromes, including sepsis (1,400, 15.7%) and pneumonia (867, 9.8%). The drug utilisation index (DU75) consisted of ceftriaxone, metronidazole, gentamicin and ampicillin, which accounted for 76.9% (12,291\/15,989) of total antibiotic use. The distribution of prescribed antibiotics was 46.6% Access, 45.5% Watch, 0.1% Reserve and 7.7% unrecommended combinations. Overall, 5,402 (60.8%) prescriptions were aligned with national guidelines, 2,147 (24.1%) prescriptions were issued without an indication, and CST guided 271 (3%) prescriptions. Over time, there was no significant change in antibiotic prescription prevalence (slope=0.09, CI \u22120.93 to 1.10) and prescriptions without indication (slope=\u22120.70, CI \u22121.79 to 3.98). However, adherence to treatment guidelines (slope=2.06, CI 0.14 to 3.98) and prescriptions based on CST results (slope=0.62, CI 0.12 to 1.13) significantly increased, while \u2018\n                      <jats:italic>Watch\u2019<\/jats:italic>\n                      antibiotics prescriptions decreased (slope=\u22120.40, CI \u22120.63 to \u20130.17).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      The antibiotic prescription rate remained high, with no significant change over time. Improvements were seen in adherence to treatment guidelines, use of CST and reduced use of \u2018\n                      <jats:italic>Watch\u2019<\/jats:italic>\n                      antibiotics. Strengthening antibiotic stewardship is recommended to further improve practices.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-110251","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T14:25:37Z","timestamp":1773066337000},"page":"e110251","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Antibiotic use among patients admitted to tertiary hospitals in Uganda: a trend analysis of 2020\u20132023 point prevalence surveys"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2655-4744","authenticated-orcid":false,"given":"Suzan","family":"Nakasendwa","sequence":"first","affiliation":[{"name":"Makerere University Infectious Diseases Institute, Kampala, Uganda"},{"name":"Makerere University School of Public Health, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Mayito","sequence":"additional","affiliation":[{"name":"Makerere University Infectious Diseases Institute, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivian","family":"Twemanye","sequence":"additional","affiliation":[{"name":"Makerere University Infectious Diseases Institute, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conrad","family":"Tumwine","sequence":"additional","affiliation":[{"name":"Makerere University Infectious Diseases Institute, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reuben","family":"Kiggundu","sequence":"additional","affiliation":[{"name":"Makerere University Infectious Diseases Institute, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald","family":"Galiwango","sequence":"additional","affiliation":[{"name":"Makerere University Infectious Diseases Institute, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elly","family":"Nuwamanya","sequence":"additional","affiliation":[{"name":"Makerere University Infectious Diseases Institute, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Muleme","sequence":"additional","affiliation":[{"name":"Makerere University School of Public Health, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavia","family":"Dhikusooka","sequence":"additional","affiliation":[{"name":"Makerere University Infectious Diseases Institute, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herman","family":"Mwanja","sequence":"additional","affiliation":[{"name":"Makerere University Infectious Diseases Institute, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellon","family":"Twinomuhwezi","sequence":"additional","affiliation":[{"name":"Makerere University Infectious Diseases Institute, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harriet","family":"Akello","sequence":"additional","affiliation":[{"name":"Republic of Uganda Ministry of Health, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morries","family":"Seru","sequence":"additional","affiliation":[{"name":"Republic of Uganda Ministry of Health, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hope","family":"Mackline","sequence":"additional","affiliation":[{"name":"Makerere University Infectious Diseases Institute, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dathan M","family":"Byonanebye","sequence":"additional","affiliation":[{"name":"Makerere University Infectious Diseases Institute, Kampala, Uganda"},{"name":"Makerere University School of Public Health, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4047-6620","authenticated-orcid":false,"given":"Francis","family":"Kakooza","sequence":"additional","affiliation":[{"name":"Makerere University Infectious Diseases Institute, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Kambugu","sequence":"additional","affiliation":[{"name":"Makerere University Infectious Diseases Institute, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"2026062609355394000_16.3.e110251.1","article-title":"Antimicrobial Resistance: A Growing Serious Threat for Global Public Health","volume":"11","author":"Salam","year":"1946","journal-title":"Healthcare 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