Introduction: Since the discovery of antibiotics many substances have become available for the treatment of infections. Unfortunately, after several decades of optimism misuse or overuse of antibiotics generates unnecessary costs, produces unwanted side effects, and causes the emergence of resistant bacteria. This is considered a serious problem in developing countries where the use of antibiotic is not properly audited. Objective: The objective of this study was to observe and evaluate the appropriateness of antibiotics use and its prescribing pattern in four wards of a major University Hospital in Egypt.

Method: This prospective observational study was performed on four wards of a University Hospital. 1200 patients receiving antibiotics in wards of Surgery, Internal Medicine, Chest, and Critical Care Unit (CCU) were recruited (300 patients from each ward). The study was conducted over two years and was approved by the ethical committee of the hospital. All medication records of those patients were investigated and compared with standard guidelines and official policies of antibiotic therapy. The decision of appropriateness of antibiotic use took in consideration several factors such as the clinical data of patients, culture and sensitivity test results whenever available, and the need for dose adjustment in case of patients with renal impairment.

Results: Out of 1200 patients, 240 (20%) were considered receiving inappropriate antibiotic therapy in which 400 errors were found according to the first preference of the guidelines. The type of misuse of highest frequency was the inappropriate combination which represents 50% of the total, followed by the wrong dose regimen represented in 20% of the total. Nevertheless, higher frequency of misuse was found to be in Critical Care Unit (CCU) as more complicated cases were admitted. The pharmacists’ recommendations were found to be more accepted in the Chest ward (100%) compared to other wards; whereas recommendations about inappropriate combination were more accepted compared to any other recommendations (70%).

Conclusion: Strict guidelines and valid policies should be implemented in hospitals to decrease the antibiotic misuse and decrease the risk of microbial resistance against the current known antibiotics. The study confirms that there is a misuse of antibiotics in hospitals and that the physician needs to follow strict guidelines to prescribe antibiotics. Also, the study revealed that the acceptance of physicians to the pharmacist recommendations is low while it should be taken in consideration when prescribing antibiotics to the patients.