Abstract
Purpose: To assess current patterns of antibiotic use by carrying out two point-prevalence surveys (PPS) in Madinah after the return of hajj pilgrims from Makkah and when Madinah is free from pilgrims.
 Methods: In September 2016 and November 2016, a prospective PPS was conducted on two separate dates (during the hajj pilgrims stay in Madinah and after they leave). Data on antibiotics use were generated during these two periods. This involved an audit from all the departments of two referral hospitals (King Fahad Hospital (KFH) - 425 beds, and Al Ansar Hospital - 100 beds) of inpatients records. Data were collected using standard forms adapted from the European Centre for Disease Control (ECDC).
 Results: A total of 675 inpatients were included in PPS; among them, 332 (49.18 %) patients were receiving antibiotic therapy. In September 2016, 168 patients were treated with antibiotics, with a prevalence rate of 50.60 %, whereas, in November 2016, the prevalence rate was 49.40 %. Overall, 198 patients were identified in surgical wards, of which 132 patients (66.6 %) were receiving antibiotic therapy; 121 patients in ICU of which 70 patients (57.8 %) received antibiotics; 13 patients in other wards of which 6 (46.1 %) received antibiotic treatment; and 343 patients in medical wards of which 126 patients (36.7 %) were treated with antibiotics. There was no significant difference in prevalence of antibiotic prescribing between the two surveys (Pearson Chi-square test, p = 0.56) and with regards to patient age between the two surveys (Mann-Whitney U-test, p = 0.32).
 Conclusion: The results demonstrate that antibiotic use with adherence to hospital guidelines and PPS helps in identifying targets for quality improvement. Moreover, to escalate the prudent use of antibiotics in hospitals, PPS provides a useful tool. Furthermore, this survey provides a background to evaluate antibiotic use by a standardized methodology.
 Keywords: Point prevalence survey, Antibiotic use, Prescribing practices, Antibiotic resistance, Quality improvement, Antibiotic stewardship, Hajj, Pilgrims
Highlights
METHODSAntibiotics are used widely in modern healthcare systems and their demand increased rapidly as they target either bacterial cell reproduction or make necessary changes in cellular process or function, treat and prevent bacterial infections
This study aims to assess the prevalence of antibiotics use in two multispecialty hospitals of Madinah, Saudi Arabia
Data were recorded for all patients who were admitted as inpatients on the days of the surveys in the participating hospitals
Summary
Antibiotics are used widely in modern healthcare systems and their demand increased rapidly as they target either bacterial cell reproduction or make necessary changes in cellular process or function, treat and prevent bacterial infections. They are the most customarily prescribed drugs in the community as well in hospital settings. The close contact of pilgrims to themselves during rituals makes them vulnerable to infectious disease (6)] In these large-scale gatherings, transmission of drug-resistant organisms are of great concern to the society. There is lot of evidence which indicates that healthcare professionals are influenced by lack of accountability, physiological factors, clinical workload. while prescribing antibiotics [9]
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