Antibiotic Prescribing Practices for Paediatric Infections at Secondary Health Facilities in Benue State, North Central Nigeria

Irrational antibiotic prescribing in paediatric care contributes to antimicrobial resistance, increased treatment costs, and adverse drug events. This cross-sectional analytical study evaluates antibiotic prescribing practices for common paediatric infections at selected secondary health facilities in Benue State, North Central Nigeria. A total of 1,180 paediatric outpatient prescriptions were reviewed across six general hospitals in Makurdi, Gboko, and Otukpo over a six-month period. Prescribing indicators from the WHO/INRUD framework were applied, and the appropriateness of antibiotic choice, dose, and duration was assessed against current Standard Treatment Guidelines. Results showed that antibiotics were prescribed in 64.8% of all consultations, compared to a global benchmark of less than 30% for primary care. Amoxicillin was the most prescribed antibiotic (48.2%), followed by cotrimoxazole (22.4%) and metronidazole (14.6%). Diagnosis-led prescribing was documented in only 43.7% of cases. Antibiotic overprescription was highest for upper respiratory tract infections (83.6%) and acute watery diarrhoea (72.3%). Generic prescribing occurred in 54.9% of cases. The findings signal a critical need for antibiotic stewardship in paediatric practice. Recommendations include implementation of evidence-based treatment guidelines, prescriber training on antimicrobial stewardship principles, and introduction of facility-level antibiotic audits. Keywords: antibiotic prescribing, antimicrobial stewardship, paediatric infections, Benue State, North Central Nigeria.