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Abstract

Background: Antibiotics play a pivotal role in neonatal care, especially in Neonatal Intensive Care Units (NICUs), where newborns are highly susceptible to life-threatening infections such as sepsis. Despite their importance, antibiotics are frequently prescribed irrationally due to diagnostic uncertainty and fear of missing early infections. This irrational use not only disrupts neonatal microbial balance but also accelerates antimicrobial resistance (AMR), leading to long-term public health consequences.
Objective: To assess the patterns and prevalence of irrational antibiotic use in NICUs and identify clinical factors contributing to these practices.
Methods: A hospital-based, quantitative, cross-sectional study was conducted over a three-month period in the NICU of a public sector secondary care hospital. Data were retrospectively extracted from 180 neonates’ medical records using a structured tool. A simple random sampling method was applied to ensure representative selection. Antibiotic use was evaluated against World Health Organization (WHO) guidelines and national neonatal protocols to determine rationality. Data analysis was performed using SPSS version 25, with descriptive statistics presented in frequencies and percentages, and chi-square tests applied to examine associations, considering p < 0.05 as statistically significant.
Results: Among 180 neonates, 48.8% received ampicillin + gentamicin, 22.2% were prescribed ceftriaxone, and 15.6% received meropenem. Only 13 neonates (7.2%) had blood cultures obtained prior to initiating antibiotics. Irrational antibiotic use was significantly more common in preterm neonates (57.1%, p = 0.04) and those who received antibiotic therapy beyond five days (70%, p = 0.03). Rational prescribing was strongly associated with the practice of sending cultures before treatment (60% rational vs. 40% irrational, p = 0.01).
Conclusion: The study highlights a high prevalence of irrational antibiotic use in NICUs, mainly driven by lack of culture diagnostics and unnecessarily prolonged therapy. Strengthening antimicrobial stewardship and improving diagnostic protocols are urgently needed to ensure safe and effective neonatal care.