Antibiotic Prescribing Behaviour Among Different Healthcare Cadres: Evidence from Primary Health Care Facilities in Osogbo, Nigeria

Abstract

Background: Inappropriate antibiotic prescribing in primary healthcare settings is a major driver of antimicrobial resistance (AMR), particularly in low- and middle-income countries. In Osogbo Local Government Area, Osun State, Nigeria, primary health centres serve as the primary entry point for infectious disease management, yet prescribing practices often deviate from evidence based guidelines due to systemic constraints. Objective: This review synthesises evidence on antibiotic prescribing behaviours among healthcare cadres in primary care facilities in Osogbo, Nigeria, examining prevalence, determinants, impacts, and existing interventions. Findings: Global outpatient antibiotic prescribing prevalence is 34.3%, with low-income economies reporting 67.5%. In Osun State, antibiotic use among hospitalised patients is 76.6%, with 96.5% of prescriptions being empirical and 94.8% of surgical prophylaxis exceeding 24 hours. Key determinants include provider knowledge gaps (only 22.3% of Nigerian physicians demonstrate adequate AMR knowledge), institutional factors (lack of operational policies, drug availability issues, and pharmaceutical marketing pressure), and patient-related pressures (58.3% of prescribers cite patient insistence). Consequences include adverse drug events, increased healthcare costs (resistant infections cost 287% more to manage), and escalating AMR—currently causing 1.27 million direct deaths annually worldwide. Conclusion: Inappropriate antibiotic prescribing in Osogbo's primary health centres is pervasive, driven by multifactorial barriers. Effective interventions require context-specific strategies, including provider education, audit and feedback systems, clinical decision support tools, and strengthened regulatory enforcement.