A new study by researchers from Makerere University and the U.K.-based Nottingham Trent University has found widespread misuse of antimicrobials in Uganda’s public health facilities, raising fresh concerns about the growing threat of antimicrobial resistance.
Published in the journal Infection and Drug Resistance, the study reports an 87.2% prevalence of antimicrobial use among inpatients. Ceftriaxone was the most commonly prescribed drug in hospitals, while amoxicillin dominated outpatient prescriptions.
In an interview with URN on Wednesday, Herbert Bush Aguma, a health products management specialist at Makerere University’s College of Health Sciences and the study’s lead author, said the team examined how drugs were being used before surgery, especially antibiotics given for prophylaxis. They found that health workers often administer more doses than recommended, particularly in obstetric and gynecological procedures.
Although most medicines assessed were antibiotics, the study also reviewed other antimicrobials. Artemether-lumefantrine, a first-line malaria treatment, was the second most prescribed drug — a worrying trend, Aguma said, given emerging signs of reduced effectiveness due to resistance.
Other frequently prescribed antimicrobials included metronidazole (Flagyl), doxycycline, ciprofloxacin and benzyl penicillin, several of which appear on the global “watch list” for contributing to antimicrobial resistance. Experts warn that misuse of these medicines weakens their ability to treat common infections, driving up treatment costs and complicating care.
The study also found that antimicrobial prescribing in outpatient departments reached 60.7%, largely driven by upper respiratory tract infections — most of them viral and not requiring antibiotics.
Researchers collected data from hospitals and lower-level health facilities in Nakaseke, Wakiso and Gombe. Lower-level centers showed better adherence to national treatment guidelines, while hospitals recorded far lower compliance.
Dr. David Musoke, a public health researcher at Makerere University and co-author of the study, said misuse was widespread, based on reviews of inpatient and outpatient records to assess prescribing patterns, treatment indications and guideline adherence.
Although the study focused on central Uganda, Musoke said the findings likely reflect national trends. He added that anecdotal reports suggest some facilities may overprescribe medicines for profit, though this was not measured directly.
The authors recommend strengthening antimicrobial stewardship programs, reducing reliance on broad-spectrum antibiotics, improving diagnostic capacity and ensuring routine surveillance.
Aguma said many facilities still lack the ability to perform basic culture and sensitivity tests — essential for determining whether a drug is appropriate for a given infection. Even referral systems, such as sample transport hubs, often fail patients who need urgent care.
Musoke added that community habits, including self-medication and sharing antibiotics among family members, remain major obstacles in the fight against antimicrobial resistance.
