Abstract
BackgroundAntibiotic prescribing is common worldwide. There are several original studies about antibiotic prescribing in the healthcare setting of Iran reporting different levels of prescribing. The aim of this systematic review and meta-analysis was to determine the prevalence of antibiotic prescribing in both inpatient and outpatient settings in Iran, an example of a developing country.MethodsTo identify published studies on antibiotic prescribing, databases such as ISI, Scopus, PubMed, Google Scholar, and Electronic Persian were searched in Iran till January 2020. Eligible studies were those analyzing original data on the prescription and use of antibiotics in outpatient or inpatient settings in Iran. Moreover, all studies that used an intervention to improve antibiotic prescribing were included. The quality of the included studies was assessed using self-administered quality assessment criteria. The meta-analysis of prevalence of antibiotic prescribing was conducted based on the meta-analysis of observational studies in epidemiology guidelines. To calculate pooled rates, the random-effects model was used.ResultsA total of 54 studies (39 outpatients and 15 inpatients) were included in this study. The median of antibiotic prescribing in the outpatient and inpatient settings accounted for 45.25% and 68.2% of patients, respectively. The results of meta-analysis also showed that the antibiotic prescribing accounted for 45% of prescriptions in outpatient settings and 39.5%, 66%, and 75.3% of patients in all wards, pediatrics wards, and ICU wards of inpatient settings, respectively. The most commonly prescribed antibiotic classes in outpatient settings were penicillins, cephalosporins, and macrolides, while in inpatient settings, these were cephalosporins, penicillins, and carbapenems. There were seven studies using interventions to improve antibiotic prescribing pattern. It should be mentioned that intervention in a study had a statistically significant effect on improving antibiotic prescribing (p < .05).ConclusionPrevalence of antibiotic prescribing in Iran is high. Our findings highlight the need for urgent action to improve prescription practices. It seems that developing a national plan to improve antibiotic prescribing is necessary.
Highlights
The use of antibiotics is helpful in the treatment of patients, their irrational, excessive use has become a major concern; it has led to the spread of antibiotic resistance, one of the greatest
The results of this study showed that the rate of antibiotic prescribing in inpatient and outpatient settings in Iran was 68.2% for patients and 45.25% for prescriptions, respectively
There are different potential interventions pertaining to rational antibiotic prescribing, almost all the studies conducted in Iran have used educational interventions for physicians
Summary
The aim of this systematic review and meta-analysis was to determine the prevalence of antibiotic prescribing in both inpatient and outpatient settings in Iran, an example of a developing country. Prescribing and use of antibiotics have spread worldwide. These medications are among the most frequently used and expensive drugs for patients as well as health care organizations [1]. According to the World Health Organization (WHO), the ideal prevalence for antibiotic prescribing is 20–26.8% of prescriptions [1, 11]. The antibiotic prescribing rate is increasing and often exceeds the WHO recommendation threshold in various developed and developing countries such as USA, many European countries (such as France, Spain, Portugal, Cyprus, Iceland, Greece, and Czech Republic), Asian, and African countries (such as China, Thailand, Saudi Arabia, Jordan, and Egypt) [11–18]
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