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Infection Control in Healthcare · Journal article
Journal of Health Population and Nutrition · August 27, 2026
Early or partial results. Treat as a signal, not a conclusion.
This multisite point prevalence survey documents antibiotic prescribing practices in seven Malawian sentinel surveillance hospitals, finding 46.1% of inpatients on antibiotics with predominantly empirical prescribing and variable guideline compliance (58–90%) across sites. The data establish a baseline for antimicrobial stewardship efforts but do not demonstrate efficacy of any intervention or causal drivers of prescribing patterns.
Multisite, cross-sectional point prevalence survey. Inpatients in seven antimicrobial resistance sentinel surveillance network hospitals in Malawi, with 1,030 eligible patient files reviewed.. n = 1,030. Seven hospitals in Malawi: Queen Elizabeth Central Hospital, Zomba Central Hospital, Kamuzu Central Hospital, Mzuzu Central Hospital, Mangochi District Hospital, Mzimba South District Hospital, and M….
46.1% (475/1,030; 95% CI: 43.1–49.2) of reviewed patient files were for patients on antibiotics Three most frequently prescribed antibiotics: ceftriaxone 36.5%, metronidazole 20.6%, benzylpenicillin 14.8%, together >70% of all prescriptions (n=724) 58.7% of prescriptions were Access category agents; 41.3% Watch category; zero Reserve category prescribed
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
This survey provides baseline prescribing data to inform antimicrobial stewardship programmes in Malawi but does not directly change clinical practice; findings identify targets for intervention (e.g., reducing empirical therapy, improving guideline compliance) and suggest heterogeneity in prescribing across sites that warrants investigation.
A descriptive point prevalence survey establishing baseline antibiotic prescribing patterns in Malawi, useful for surveillance but without comparator, intervention, or causal evidence to guide practice.
As stated by the source record.
Quoted from the source exactly as published.
This survey provides baseline prescribing data to inform antimicrobial stewardship programmes in Malawi but does not directly change clinical practice; findings identify targets for intervention (e.g., reducing empirical therapy, improving guideline compliance) and suggest heterogeneity in prescribing across sites that warrants investigation.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Abstract Background Antimicrobial resistance threatens global health and is largely driven by inappropriate antimicrobial use. In Malawi, infectious diseases remain the leading health burden, fueling high antibiotic consumption. However, systematic data on antibiotic prescribing practices are scarce. This study evaluated the prevalence and pattern of antibiotic use for inpatients admitted in hospitals participating in Malawi’s antimicrobial resistance sentinel surveillance network. Methods A multisite point prevalence survey on antibiotic use was conducted in June 2021 across seven hospitals in the sentinel surveillance network: Queen Elizabeth Central Hospital, Zomba Central Hospital, Kamuzu Central Hospital, Mzuzu Central Hospital, Mangochi District Hospital, Mzimba South District Hospital, and Malamulo Adventist Hospital. Antibiotic prescription data was collected from randomly selected patient medical records using the World Health Organization methodology for point prevalence surveys on antibiotic use. Four domains were described: antibiotic-use prevalence, patterns of antibiotic use, local guideline compliance, and microbiology diagnostic service use. Results A total of 1,030 eligible patient files were reviewed across the surveyed hospitals, of which 46.1% (475/1030; 95% CI: 43.1–49.2) were patients on antibiotics. 51% (244/475) of the patients on antibiotics were prescribed only one class of antibiotic while the remainder had more than one. Among patients using antibiotics, 724 prescriptions were analyzed. The three most frequently prescribed antibiotics were ceftriaxone (36.5%), metronidazole (20.6%), and benzylpenicillin (14.8%), together accounting for over 70% of all prescriptions. Overall, 58.7% of prescriptions were Access category agents, while 41.3% were in the Watch category; no Reserve category agents were prescribed. The most common indications were prophylaxis (unspecific) (17.3%; 125/724), clinical sepsis (17.1%; 124/724), and pneumonia (12.8%; 93/724). Compliance to the Malawi Standard Treatment Guidelines ranged from 58% at Zomba and Kamuzu Central Hospitals to over 90% at Mzuzu Central and Mzimba South District Hospitals. Prescribing was predominantly empirical, with more than 95% empirical therapy at most sites, apart from Queen Elizabeth Central Hospital (39%) and Malamulo (10%). Conclusion These baseline findings from antimicrobial resistance surveillance hospitals in Malawi highlight opportunities to strengthen antimicrobial stewardship through more appropriate antibiotic selection, greater use of Access category antibiotics where clinically indicated, and improved integration of microbiology services into prescribing decisions.
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