A new study by researchers from Makerere University and the UK-based Nottingham Trent University has uncovered widespread misuse of antimicrobials in Uganda’s public health facilities, raising fresh concerns about the escalating threat of antimicrobial resistance (AMR).
Published in the Infection and Drug Resistance journal, the study reports an 87.2 per cent prevalence of antimicrobial use among inpatients, with ceftriaxone emerging as the most frequently prescribed drug in hospitals, while amoxicillin dominated prescriptions in outpatient settings.
In an interview with our reporter on Wednesday, Herbert Bush Aguma, a Health Products Management Specialist at Makerere University’s College of Health Sciences and the study’s lead researcher, said the team assessed drug administration patterns before surgery, particularly the use of antibiotics for prophylaxis.
They discovered that health workers commonly administer more doses than recommended, especially in obstetric and gynaecological procedures.
Aguma noted that while most of the medicines assessed were antibiotics, the study also included a wider range of antimicrobials, not limited to bacterial infections. For instance, artemether-lumefantrine, a key malaria treatment, was the second most prescribed drug. This growing reliance is concerning, given emerging research indicating signs of reduced effectiveness due to resistance.
Other commonly prescribed antimicrobials included metronidazole (Flagyl), doxycycline, ciprofloxacin, and benzyl penicillin, several of which are already on the global “watch list” for contributing to antimicrobial resistance. Global health experts warn that misuse of such medicines undermines their ability to treat everyday infections, eventually making treatment for even simple illnesses more expensive and difficult.
The study further revealed that in outpatient departments, antimicrobial prescribing stood at 60.7 per cent, driven largely by treatment of upper respiratory tract infections, the majority of which are viral and do not require antibiotics.
The researchers collected data from both high-level hospitals and lower health facilities in Nakaseke, Wakiso, and Gombe. Interestingly, lower-level facilities demonstrated stronger adherence to national treatment guidelines, while hospitals recorded significantly lower compliance.
Dr David Musoke, a public health researcher at Makerere University and co-author of the study, said many antibiotics were being misused, a conclusion drawn from reviewing both inpatient and outpatient records to assess prescribing patterns, treatment indications, and adherence to guidelines.
While the findings reflect only the facilities studied in central Uganda, Musoke said they likely mirror what is happening across the country. He added that anecdotal evidence suggests some facilities may be overprescribing medicines for profit, although this was not directly measured in the research.
The authors of the study recommend strengthening antimicrobial stewardship programmes, reducing dependency on broad-spectrum antibiotics, enhancing diagnostic support, and ensuring routine surveillance.
Aguma emphasised that many facilities lack the capacity to conduct basic culture and sensitivity tests, a key step in determining whether a particular drug is appropriate for a specific infection. Even referral mechanisms, such as the hub system for transporting samples to larger laboratories, are often impractical when patients require urgent treatment.
Musoke added that although the study focused on health facilities, community behaviour, such as self-medication and sharing antibiotics among family members, remains one of the biggest obstacles in the fight against AMR.
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