The demographic profile showed that out of the 451 prescriptions that had antibiotics, higher number of females (70.44%) than males (28.89%) utilized antibiotics. This is similar to an earlier report4 but varies to another studies7,15. The probable reasons for the more females than males utilizing antibiotics, as seen in our study may be due to the sociological factors or that the female population was more exposed to environmental influences such that they get more infectious diseases . Patients in the age group of 36–40 years (10%) for males and 46–50 years (17.03%) for females were prescribed maximum antibiotics and patients in the age group of 81–85 years (0.769%) for males and 86–90 years (0%) were prescribed the least amount of antibiotics. Generally, the age group, 46–50 had the highest antibiotic prescriptions across the both gender (13.56%), followed by the 41–45 (12.44%).
Irrational use of antibiotics is a significant contributor to the development of antibiotic resistance . Antibiotic resistance has posed a significant threat to the management of infectious diseases and the incidence of antibiotic resistance is increasing day by day. Urgent steps are needed to promote the rational use of antibiotics. Antibiotics utilization study can help in fostering the habits of rational use of antibiotics which means at the right dose, for the right duration, and at the right cost. Antibiotics are an important category of drugs and its improper use can result in antibiotic resistance. One of the causes of resistance against antibiotics is the high number of antibiotics prescribed for patients per encounter . The average number of drugs per prescription is an important parameter while doing a prescription audit. Multiple drug prescribing results in poly-pharmacy; this may attribute to irrational prescribing and adverse effects. In this study, the average number of antibiotics per prescription was 1.26 same to the study organized in a hospital in Guwahati . Some other studies have reported an average number of antibiotics per the prescription of 1.83, 1.8 and 1.6 respectively [18, 19, 20]. Also, it was found that even though the number of prescriptions with one antibiotics was higher than that with two, and then with three, the average number of drugs per prescription that had one antibiotic was 4.28, with two antibiotics was 4.46, and that which had three antibiotics was 5.55, which is more than double the average number (i.e., 2) recommended by WHO and in several countries (Indonesia, Niger, Nigeria, India, Ghana, and Pakistan) the prescriptions were for three or more drugs .
Essential medicine list or formulary issued to measure the degree to which practices conform to national drug policy, as indicated by prescribing from the national essential medicines list or formulary for the type of facility surveyed. A total number of 617 antibiotics were prescribed in 450 prescriptions. As per WHO drug use indicators, out of the total antibiotics prescribed, 379 (84.22%) were from the Nigerian Essential Medicines List. The most common antibiotics prescribed were Amino-penicillins (37.28%) mainly coamoxiclav 625 mg followed by Nitroimidazoles (17.99%) mostly metronidazole, Fluoroquinolones (17.18%) mostly ciprofloxacin, Macrolides (13.29%), Cephalosporins (9.24%), Tetracyclines (3.08%), and Lincosamides (0.32%). This is similar to an earlier report by Yimenu et al, who observed prescribed antibiotic in this sequence: Penicillin > Macrolid > Fluoroquinolons > Cephalosporin > Tetracyclines . Amino-penicillins are bactericidal beta-lactam antibiotics. They are effective against most gram-positive bacteria and are clinically used in treating upper and lower respiratory tract infections, endocarditis urinary tract infection and others. Similarly an earlier report  indicates that most antibiotics prescriptions in the adult outpatient unit are against medical conditions as listed. Essential medicine lists have been shown to improve the quality and cost-effectiveness of health care delivery when combined with proper procurement policies and good prescribing practices. Adequately, in this study, most of the antibiotics were prescribed from the essential medicines list.
The percentage of encounter with injections prescribed was very less than the ideal value of World Health Organization (13.4% − 24.1%) where it was found to be 1.8%. Most of the prescriptions were in oral dosage forms. This may be due to patient visits in the out-patient department, General out-patient department (GOPD) only at a less severe stage where extra care is not needed. The less use of injection leads to decreased cost of medication, less tissue necrosis, less anaphylactic shock, reduces chances of transmission of blood-borne diseases, including HIV . A similar result was obtained by Yimenu et al while assessing the antibiotic prescribing patterns using World Health Organization prescribing indicators at the outpatient Pharmacy Department of University of Gondar referral hospital, Gondar, Northwest Ethiopia, reported that majority of antibiotics were prescribed by oral route (476, 84%) followed by the parenteral route (39, 4%), as observed in this study .