Antibiotic Use at Two Central Referral Hospitals in Zimbabwe: A Retrospective Analysis of Prescribing Patterns

Background: The quality of antibiotic use is closely linked to the emergence of antibiotic resistance. Growing antibiotic misuse and resistance are making previously treatable infections harder to manage, increasing morbidity, mortality, and healthcare costs. This study provides an in-depth assessment of current antibiotic use in the Zimbabwean public hospital sector, using follow-up indicators that were absent from previous national surveys. Methods: A retrospective review of inpatient medical records was conducted at Parirenyatwa and Harare Central Hospitals. Records generated between 1 January 2015 and 31 January 2016 were reviewed for adults at both sites; pediatrics records at Harare covered 1 January to 30 September 2016. Systematic sampling was used to select records, and WHO drug-use indicator methodology was applied. Results: Of 1181 records reviewed, 60.6–69.0% (60–70% overall) included at least one antibiotic. Ceftriaxone was the most frequently prescribed antibiotic (27.3% of all antibiotics). Injections were the main route of administration (55.2–69.8%). Almost all antibiotics (97.7–99.9%) were prescribed from the essential drug list, and 61.3–67.2% were prescribed generically. Broad-spectrum antibiotics predominated (57–63%). Switches from injectable to oral therapy accounted for the majority of antibiotic switches (66–76%). Prophylaxis was the leading indication for antibiotic therapy. A microbial sensitivity test was requested in only 11.5–12.0% of antibiotic-treated encounters. Conclusion: Antibiotic use at these two central hospitals is high, with more than half of admitted patients receiving antibiotics, largely without microbiological confirmation. These findings justify strengthened antimicrobial stewardship, improved laboratory support, and the development of a national antibiotic use policy for Zimbabwe.