Are antibiotic prescription practices in Eastern Uganda concordant with the national standard treatment guidelines? A cross-sectional retrospective study

•Assessment of antibiotic prescription patterns and their accordance with treatment guidelines in Uganda.•High percentage of inappropriate antibiotic prescription in Eastern Uganda (82.6%).•More non-adherence to guidelines when prescribing antibiotics for males or children (0–12 years).•Need for studies that link diagnostic and laboratory data to prescribing data. This study aimed to evaluate the antibiotic prescription patterns of health workers in Eastern Uganda and more specifically whether they are in accordance with the Ugandan standard treatment guidelines and other indicators of appropriate antimicrobial prescription. Patient data were obtained from the health management information system of the outpatient department registers of Soroti and Mbale Regional Referral Hospitals from 2016–2018. The prevalence of non-adherence to treatment guidelines when prescribing antibiotics was 82.6% (95% CI 81.4–83.7%). Guidelines were more likely to be adhered to when prescribing antibiotics for individuals aged 13–19 years compared with their counterparts aged 0–12 years [adjusted odds ratio (aOR) = 0.55, 95% CI 0.40–0.74]. When prescribing antibiotics for males, health workers were twice as likely not to adhere to guidelines compared with when prescribing for females (aOR = 2.09, 95% CI 1.61–2.72). When prescribing cephalosporins and nitroimidazoles, health workers were likely not to adhere to guidelines compared with when prescribing penicillin (cephalosporins, aOR = 1.92, 95% CI 1.28–2.86; nitroimidazoles, aOR = 1.70, 95% CI 1.09–2.65). Health workers were most likely not to follow guidelines when prescribing antibiotics in combination (two antibiotics, aOR = 1.27, 95% CI 1.03–1.56). Non-adherence to treatment guidelines for an indicated diagnosis and inappropriate antibiotic prescription are significantly prevalent in Eastern Uganda. Health workers were more likely not to follow guidelines when prescribing for males, children up to 12 years of age and when prescribing cephalosporins, nitroimidazoles or double antibiotic combinations.