Abstract

Background Ear, nose and throat (ENT) infections are often associated with high levels of morbidity and mortality. Antibiotic overuse and misuse for most ENT infections have been reported, caused by a lack of expertise or uncertainties to distinguish between infection types. This study sought to determine the level of appropriateness of antibiotics for ENT infections and its associated factors in ambulatory care in a teaching hospital in Ghana to guide future policies given rising resistance rates. Methods A retrospective cross-sectional study design was undertaken to audit the quality of antibiotic use in Ho Teaching Hospital, a leading teaching hospital in Ghana, between January 2022 to December 2022. A checklist was designed to extract patient socio-demographic and clinical information from electronic medical records. The main study outcome was the appropriate choice of antibiotics principally in accordance to the Ghana standard treatment guidelines. Descriptive, bivariate and multivariate analyses were performed on the data collected using STATA version 14. Results The electronic medical records of a total of 3,279 patients were extracted. The majority (57.88%, n = 1898) of patients were females, median (inter-quartile range) age was 25 [7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42] years. Ear infections were the commonest (66.24%, n = 2172) diagnosed ENT infection, followed by throat infections (15.74%, n = 516). The most prescribed antibiotic was oral amoxicillin-clavulanic acid together with a topical neomycin-steroid combination (28.00%, n = 918), followed by amoxicillin-clavulanic acid alone (18.69%, n = 613). The appropriate choice of antibiotic for all ENT infections in accordance with treatment guidelines was 60.11%. Inappropriate use of antibiotics was high when more than one antibiotic and World Health Organisation (WHO) ‘Watch’ group antibiotics were prescribed and ear infections compared to the nose and throat infections were treated. Conclusion The appropriateness of antibiotic use for ENT infections in this hospital was suboptimal. It was predicted by the type of infection, the number of antibiotics prescribed and the WHO AWaRe group. Antimicrobial stewardship interventions such as clinical audit with feedback and clinician education must be enhanced to among other things identify antibiotic use gaps to help reduce unnecessary use of antibiotics for ENT infections.