A new research conducted by Makerere University in collaboration with the UK’s Nottingham Trent University has revealed extensive misuse of antimicrobials across Uganda’s public health facilities, intensifying concerns about the growing threat of antimicrobial resistance (AMR).

Appearing in the journal Infection and Drug Resistance, the research shows that antimicrobial use among hospitalised patients reached 87.2 per cent. Ceftriaxone was identified as the most commonly prescribed antibiotic in inpatient wards, whereas amoxicillin was most frequently used in outpatient care.

Herbert Bush Aguma, lead investigator and Health Products Management Specialist at Makerere University’s College of Health Sciences explained that the study analysed patterns of drug use around surgical procedures, particularly the application of antibiotics for prophylaxis.

According to Aguma, the researchers found that health workers routinely gave more doses than recommended, with the trend especially evident in obstetric and gynaecological surgeries.

He further noted that although antibiotics accounted for most of the medicines reviewed, the survey encompassed a broad range of antimicrobials beyond those targeting bacterial infections. Artemether-lumefantrine, a primary malaria therapy, was the second most frequently prescribed drug. Its rising use is troubling, Aguma said, given new evidence suggesting declining effectiveness linked to resistance.

Among the other drugs frequently issued were metronidazole (Flagyl) doxycycline, ciprofloxacin and benzyl penicillin, several of which appear on the global “watch list” for their role in driving antimicrobial resistance. Public health specialists caution that misuse of such medicines weakens their ability to combat common infections, ultimately making treatment costlier and harder.

In outpatient departments, the study found that antimicrobials were prescribed in 60.7 per cent of cases, largely for upper respiratory tract infections, conditions that are mainly viral and therefore do not typically require antibiotic therapy.

Data for the study was gathered from high-tier hospitals as well as lower-level facilities in Nakaseke, Wakiso and Gombe. Surprisingly, the researchers observed that smaller facilities adhered more closely to national treatment guidelines than hospitals, which demonstrated far poorer compliance.

Dr David Musoke, a public health expert at Makerere University and co-author of the study, said the analysis of records from both outpatient and inpatient units clearly indicated inappropriate antibiotic use. This conclusion was based on evaluating prescribing patterns, the conditions being treated and the extent to which clinicians followed treatment guidelines.

Although the findings reflect only selected facilities in central Uganda, Musoke suggested they likely represent nationwide trends. He also mentioned that anecdotal accounts point to overprescribing in some places for financial gain, although this was not directly assessed.

To address the issues identified, the authors call for strengthened antimicrobial stewardship, reduced reliance on broad-spectrum antibiotics, improved diagnostic capacity and consistent surveillance.

Aguma stressed that many facilities do not have the ability to perform essential culture and sensitivity tests, which are crucial for selecting the right treatment. Even systems intended to support referrals, such as the hub model for sending samples to larger laboratories often fail to meet the needs of patients who require immediate care.

Musoke added that despite the study’s focus on health facilities, community practices such as self-medication and sharing antibiotics among relatives remain major barriers to tackling AMR.