{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T20:40:17Z","timestamp":1788381617361,"version":"build-2803163510"},"reference-count":40,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,12,8]],"date-time":"2022-12-08T00:00:00Z","timestamp":1670457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Excessive antimicrobial use contributes to the development of antimicrobial resistance. In the Eastern Mediterranean region (EMR), there is dearth of information on the prevalence of antimicrobial use in patients hospitalized in acute healthcare settings, clinical indications, types of antimicrobials prescribed, and quality indicators for prescriptions. Between September and December 2019, seven countries in the EMR conducted a standardized point prevalence survey. All patients present in the hospital wards at 8 a.m. on the day of the survey constituted the sample population. We collected data, including patient characteristics, antimicrobials received, therapeutic indication according to predefined lists, and markers of prescribing quality. The survey included data from 139 hospitals in seven countries. Among the 19,611 inpatients surveyed, 11,168 patients received at least one antimicrobial {crude prevalence: 56.9% (95%CI: 56.2\u201357.6%). The top three classes of antimicrobials prescribed were third-generation cephalosporins (26.7%), beta-lactam penicillins (18.1%), and imidazole derivatives (n = 1655, 9.8%). Carbapenems were most frequently prescribed for the treatment of healthcare-associated infections. Compliance with quality indicators of antimicrobial use was limited where treatment guidelines were available for 41% of antimicrobial prescriptions and targeted antimicrobial treatment represented 21% of therapeutic indications. Overall hospital antimicrobial use was high in countries of the EMR, pointing to the need to design and implement context-specific antimicrobial stewardship programs to optimize antimicrobial use and reduce antimicrobial resistance.<\/jats:p>","DOI":"10.3390\/antibiotics11121773","type":"journal-article","created":{"date-parts":[[2022,12,8]],"date-time":"2022-12-08T02:51:56Z","timestamp":1670467916000},"page":"1773","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Over-Prescription and Overuse of Antimicrobials in the Eastern Mediterranean Region: The Urgent Need for Antimicrobial Stewardship Programs with Access, Watch, and Reserve Adoption"],"prefix":"10.3390","volume":"11","author":[{"given":"Maha","family":"Talaat","sequence":"first","affiliation":[{"name":"Antimicrobial Resistance and Infection Prevention and Control Unit, Universal Health Coverage, Communicable Diseases Department, Eastern Mediterranean Office, World Health Organization, Cairo P.O. Box 7608, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Tolba","sequence":"additional","affiliation":[{"name":"Antimicrobial Resistance and Infection Prevention and Control Unit, Universal Health Coverage, Communicable Diseases Department, Eastern Mediterranean Office, World Health Organization, Cairo P.O. Box 7608, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4222-0453","authenticated-orcid":false,"given":"Enjy","family":"Abdou","sequence":"additional","affiliation":[{"name":"Antimicrobial Resistance and Infection Prevention and Control Unit, Universal Health Coverage, Communicable Diseases Department, Eastern Mediterranean Office, World Health Organization, Cairo P.O. Box 7608, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Sarhan","sequence":"additional","affiliation":[{"name":"Antimicrobial Resistance and Infection Prevention and Control Unit, Universal Health Coverage, Communicable Diseases Department, Eastern Mediterranean Office, World Health Organization, Cairo P.O. Box 7608, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Gomaa","sequence":"additional","affiliation":[{"name":"Antimicrobial Resistance and Infection Prevention and Control Unit, Universal Health Coverage, Communicable Diseases Department, Eastern Mediterranean Office, World Health Organization, Cairo P.O. Box 7608, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1110-6794","authenticated-orcid":false,"given":"Yvan J-F.","family":"Hutin","sequence":"additional","affiliation":[{"name":"Department of Universal Health Coverage\/Communicable Diseases Prevention and Control, Eastern Mediterranean Office, World Health Organization, Cairo P.O. Box 7608, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,8]]},"reference":[{"key":"ref_1","unstructured":"Antimicrobial Resistance Collaborators (2022). Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. Lancet, 399, 629\u2013655."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"36","DOI":"10.4103\/jgid.jgid_110_18","article-title":"Global Contributors to Antibiotic Resistance","volume":"11","author":"Sifri","year":"2019","journal-title":"J. Glob. Infect. Dis."},{"key":"ref_3","unstructured":"O\u2019Neill, J. (2016). Tackling Drug-Resistant Infections Globally: Final Report and Recommendations, Review on Antimicrobial Resistance."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e619","DOI":"10.1016\/S2214-109X(18)30186-4","article-title":"Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: Results of an internet-based global point prevalence survey","volume":"6","author":"Versporten","year":"2018","journal-title":"Lancet Glob. Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1186\/s13756-020-00758-x","article-title":"The 2017 Global Point Prevalence Survey of Antimicrobial Consumption and Resistance in Canadian Hospitals","volume":"9","author":"Frenette","year":"2020","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/S1473-3099(17)30724-7","article-title":"Classifying Antibiotics in the WHO Essential Medicines List for Optimal Use\u2014Be AWaRe","volume":"18","author":"Sharland","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1016\/S1473-3099(19)30532-8","article-title":"Encouraging AWaRe-ness and discouraging inappropriate antibiotic use-the new 2019 Essential Medicines List becomes a global antibiotic stewardship tool","volume":"19","author":"Sharland","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"717","DOI":"10.3201\/eid2804.211975","article-title":"Increasing Antimicrobial Resistance in World Health Organization Eastern Mediterranean Region, 2017\u20132019","volume":"28","author":"Talaat","year":"2022","journal-title":"Emerg. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1800393","DOI":"10.2807\/1560-7917.ES.23.46.1800393","article-title":"Antimicrobial Use in European Acute Care Hospitals: Results from the Second Point Prevalence Survey (PPS) of Healthcare-Associated Infections and Antimicrobial Use, 2016 to 2017","volume":"23","author":"Plachouras","year":"2018","journal-title":"Eurosurveillance"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.ijid.2019.06.016","article-title":"One-Day Point Prevalence of Healthcare-Associated Infections and Antimicrobial Use in Four Countries in Latin America","volume":"86","author":"Braga","year":"2019","journal-title":"Int. J. Infect. Dis."},{"key":"ref_11","first-page":"1900015","article-title":"Antimicrobial Use in Acute Care Hospitals: National Point Prevalence Survey on Healthcare-Associated Infections and Antimicrobial Use, Switzerland, 2017","volume":"24","author":"Zingg","year":"2019","journal-title":"Eurosurveillance"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S61","DOI":"10.1093\/cid\/cix103","article-title":"Prevalence of Healthcare-Associated Infections and Antimicrobial Use Among Adult Inpatients in Singapore Acute-Care Hospitals: Results From the First National Point Prevalence Survey","volume":"64","author":"Cai","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Bubakar, U. (2020). Antibiotic Use among Hospitalized Patients in Northern Nigeria: A Multicenter Point-Prevalence Survey. BMC Infect. Dis., 20.","DOI":"10.1186\/s12879-020-4815-4"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1080\/14787210.2019.1629288","article-title":"Point Prevalence Study of Antimicrobial Use among Hospitals across Botswana; Findings and Implications","volume":"17","author":"Tiroyakgosi","year":"2019","journal-title":"Expert Rev. Anti-Infect. Ther."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Kiggundu, R., Wittenauer, R., Waswa, J., Nakambale, H.N., Kitutu, F.E., Murungi, M., Okuna, N., Morries, S., Lawry, L.L., and Joshi, M.P. (2022). Point Prevalence Survey of Antibiotic Use across 13 Hospitals in Uganda. Antibiotics, 11.","DOI":"10.3390\/antibiotics11020199"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1093\/jac\/dkz348","article-title":"Impact of National Interventions to Promote Responsible Antibiotic Use: A Systematic Review","volume":"75","author":"Lim","year":"2019","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"E3463","DOI":"10.1073\/pnas.1717295115","article-title":"Global Increase and Geographic Convergence in Antibiotic Consumption between 2000 and 2015","volume":"115","author":"Klein","year":"2018","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Bediako-Bowan, A.A.A., Owusu, E., Labi, A.-K., Obeng-Nkrumah, N., Sunkwa-Mills, G., Bjerrum, S., Opintan, J.A., Bannerman, C., M\u00f8lbak, K., and Kurtzhals, J.A.L. (2019). Antibiotic Use in Surgical Units of Selected Hospitals in Ghana: A Multi-Centre Point Prevalence Survey. BMC Public Health, 19.","DOI":"10.1186\/s12889-019-7162-x"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.jiph.2018.09.003","article-title":"Point Prevalence Survey of Antibiotic Use in 26 Saudi Hospitals in 2016","volume":"12","author":"Enani","year":"2019","journal-title":"J. Infect. Public Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1093\/jac\/dkx494","article-title":"Antimicrobial Usage in German Acute Care Hospitals: Results of the Third National Point Prevalence Survey and Comparison with Previous National Point Prevalence Surveys","volume":"73","author":"Aghdassi","year":"2018","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s13756-019-0663-7","article-title":"Point Prevalence Survey of Antimicrobial Use and Healthcare-Associated Infections in Belgian Acute Care Hospitals: Results of the Global-PPS and ECDC-PPS 2017","volume":"9","author":"Vandael","year":"2020","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_22","unstructured":"World Health Organization (2016). Global Guidelines for the Prevention of Surgical Site Infection, World Health Organization."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"dlab047","DOI":"10.1093\/jacamr\/dlab047","article-title":"A multicentre point prevalence survey of patterns and quality of antibiotic prescribing in Indonesian hospitals","volume":"3","author":"Limato","year":"2021","journal-title":"JAC-Antimicrob. Resist."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"450","DOI":"10.3390\/antibiotics3030450","article-title":"A Point Prevalence Survey of Antibiotic Use in 18 Hospitals in Egypt","volume":"3","author":"Talaat","year":"2014","journal-title":"Antibiotics"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Rachina, S., Belkova, Y., Kozlov, R., Versporten, A., Pauwels, I., Goossens, H., Bochanova, E., Domanskaya, O., Elokhina, E., and Ezhova, L. (2020). Longitudinal Point Prevalence Survey of Antimicrobial Consumption in Russian Hospitals: Results of the Global-PPS Project. Antibiotics, 9.","DOI":"10.3390\/antibiotics9080446"},{"key":"ref_26","first-page":"19","article-title":"A Multicentre Point Prevalence Survey of Hospital Antimicrobial Prescribing and Quality Indices in the Kurdistan Region Government of Northern Iraq: The Need for Urgent Action","volume":"6","author":"Kurdi","year":"2020","journal-title":"SSRN Electron. J."},{"key":"ref_27","first-page":"20","article-title":"A Cross-Sectional Study on Knowledge, Attitude and Practices of Medical Doctors towards Antibiotic Prescribing Patterns and Resistance in Khyber Pakhtun Khawah, Pakistan","volume":"7","author":"Faizullah","year":"2017","journal-title":"J. Appl. Pharm. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1080\/14787210.2021.1898946","article-title":"A Point Prevalence Survey of Antimicrobial Utilisation Patterns and Quality Indices amongst Hospitals in South Africa; Findings and Implications","volume":"19","author":"Skosana","year":"2021","journal-title":"Expert Rev. Anti-Infect. Ther."},{"key":"ref_29","unstructured":"(2022, March 10). Who.int. Available online: https:\/\/www.who.int\/publications\/i\/item\/2021-aware-classification."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"550","DOI":"10.2471\/BLT.20.270934","article-title":"Progress towards Antibiotic Use Targets in Eight High-Income Countries","volume":"99","author":"Simmons","year":"2021","journal-title":"Bull. World Health Organ."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1080\/22221751.2020.1754133","article-title":"Colistin and Its Role in the Era of Antibiotic Resistance: An Extended Review (2000\u20132019)","volume":"9","author":"Zhong","year":"2020","journal-title":"Emerg. Microbes Infect."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/S0140-6736(15)00474-2","article-title":"Access to Effective Antimicrobials: A Worldwide Challenge","volume":"387","author":"Laxminarayan","year":"2016","journal-title":"Lancet"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1016\/j.cmi.2017.07.010","article-title":"Antibiotic Stewardship in Low- and Middle-Income Countries: The Same but Different?","volume":"23","author":"Cox","year":"2017","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Jamaluddin, N.A.H., Periyasamy, P., Lau, C.L., Ponnampalavanar, S., Lai, P.S.M., Ramli, R., Tan, T.L., Kori, N., Yin, M.K., and Azman, N.J. (2021). Point Prevalence Survey of Antimicrobial Use in a Malaysian Tertiary Care University Hospital. Antibiotics, 10.","DOI":"10.3390\/antibiotics10050531"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Rizk, N.A., Moghnieh, R., Haddad, N., Rebeiz, M.-C., Zeenny, R.M., Hindy, J.-R., Orlando, G., and Kanj, S.S. (2021). Challenges to Antimicrobial Stewardship in the Countries of the Arab League: Concerns of Worsening Resistance during the COVID-19 Pandemic and Proposed Solutions. Antibiotics, 10.","DOI":"10.3390\/antibiotics10111320"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s13756-019-0493-7","article-title":"Implementation of Antibiotic Stewardship in Different Settings\u2014Results of an International Survey","volume":"8","author":"Charani","year":"2019","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_37","unstructured":"(2018). WHO Methodology for Point Prevalence Survey on Antibiotic Use in Hospitals, World Health Organization."},{"key":"ref_38","unstructured":"StataCorp (2016). Stata Statistical Software: Release 13, StataCorp LP."},{"key":"ref_39","unstructured":"(2022, July 24). WHOCC\u2014Application for ATC Codes. Available online: https:\/\/www.whocc.no\/atc\/application_for_atc_codes\/."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1614","DOI":"10.1093\/jac\/dkab050","article-title":"Global-PPS network. Hospital antibiotic prescribing patterns in adult patients according to the WHO Access, Watch and Reserve classification (AWaRe): Results from a worldwide point prevalence survey in 69 countries","volume":"76","author":"Pauwels","year":"2021","journal-title":"J. Antimicrob. Chemother."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/11\/12\/1773\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:36:15Z","timestamp":1760146575000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/11\/12\/1773"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,8]]},"references-count":40,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["antibiotics11121773"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics11121773","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,8]]}}}