Antimicrobial prescribing varied widely across Middle Eastern hospitals

A systematic review and meta-analysis found that 58.6% of hospitalised patients in the Middle East received antimicrobial medicines at the surveyed point in time, with rates varying substantially among countries. The estimate was based on 31 eligible point-prevalence studies identified from 1,515 records, most of which came from Saudi Arabia and Turkey. The researchers said the results point to a need for stronger antimicrobial stewardship in acute-care hospitals, while also highlighting gaps in the documentation of prescribing decisions.

The study followed PRISMA 2020 guidance and searched PubMed, Scopus and Google Scholar for English-language primary studies published from the databases’ inception through December 2025. Included studies described the point prevalence and types of antimicrobial prescribing among hospital inpatients. Data were combined through qualitative and quantitative synthesis, with random-effects meta-analysis performed using RevMan version 5.4. The analysis examined not only how often medicines were prescribed, but also the clinical indications, antimicrobial classes, routes of administration and indicators of prescribing quality.

Country estimates ranged from 43.5% in the United Arab Emirates, with a 95% confidence interval of 23.22% to 63.77%, to 82.9% in Iraq, whose reported interval was 64.86% to 100.96%. Across the included studies, 40.8% of patients received combination therapy and 82.2% received parenteral antimicrobials. Community-acquired infections accounted for 40.5% of prescribing indications, followed by surgical antimicrobial prophylaxis at 21.3%, hospital-acquired infections at 17.7% and medical prophylaxis at 9.4%. Third-generation cephalosporins were the most frequently prescribed class, used in 22.4% of prescriptions, ahead of penicillin–beta-lactamase inhibitor combinations at 14.4% and carbapenems at 10.3%.

The analysis also assessed prescribing under the World Health Organization’s Access, Watch and Reserve framework. Access antibiotics accounted for 30.0% of prescribing, Watch antibiotics for 56.2% and Reserve antibiotics for 6.9%. The relatively high share of Watch medicines, together with the pooled use of carbapenems, was described by the authors as a concern for antimicrobial stewardship. Quality indicators were recorded less consistently: the reason for an antimicrobial prescription was documented in 69.0% of cases, while a stop or review date appeared in 40.7%. Prolonged surgical antimicrobial prophylaxis was common, reported in 79% of relevant patients. As a systematic review of point-prevalence studies, the work estimates prescribing at surveyed moments rather than tracking total use over time or establishing the clinical benefit of individual treatment decisions.

Subject of Research: Pooled antimicrobial prescribing prevalence and quality in Middle Eastern acute-care hospitals

Article Title: Antimicrobial prescribing in acute care hospitals in the Middle East: a systematic review and meta-analysis of point-prevalence studies

Article References: Abubakar, U., & Amir, O. (2026). Antimicrobial prescribing in acute care hospitals in the Middle East: a systematic review and meta-analysis of point-prevalence studies. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14342-y

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14342-y

Keywords: antimicrobial prescribing, hospital medicine, Middle East, systematic review, meta-analysis, point prevalence, antimicrobial stewardship, antibiotic use, surgical prophylaxis, Antimicrobial, prescribing, acute