Background Antimicrobials are drugs that are more likely to trigger the development of resistance naturally. Thus, they need to be prescribed, dispensed, and administered with greater caution. To underline the significance of their proper usage, antibiotics are divided as AWaRe: Access, Watch, and Reserve. Timely evidence on medicine use, prescribing patterns, and the factors affecting prescribing of antibiotic and their use percentage from AWaRe classification would help decision-makers to draft guidelines that can enable more rational use of medicines. Methods Prospective and cross-sectional study was conducted among seven community pharmacies in Dire Dawa to assess current prescribing practices related World Health Organization (WHO) indicators and AWaRe classification including antibiotic use and associated factors. Using stratified random sampling techniques, 1200 encounters were reviewed between 1 October and 31 October 2022, and SPSS version 27 was used for the analysis. Results The average of medications per prescription was 1.96. Antibiotics were included in 47.8% of encounters, while 43.1% were prescribed from the Watch groups. In 13.5% of the encounters, injections were administered. In multivariate models, patient age, gender, and the number of medications prescribed were significantly associated to prescription of antibiotics. Antibiotics were about 2.5 times more likely to be prescribed to patients under the age of 18 years than to subjects 65 years and older [adjusted odds ratio (AOR): 2.51, 95% confidence interval (CI): 1.88–5.42; P < 0.001]. Men were also more likely than women to receive an antibiotic prescription (AOR: 1.74, 95% CI: 1.18–2.33; P = 0.011). Subjects who received more than two drugs were 2.96 times more likely to receive an antibiotic drug (AOR: 2.96, 95% CI: 1.77–6.55; P < 0.003). The probability of prescribing antibiotics was increased by 2.57 for every one-unit increase in the number of medications [crude odds ratio (OR): 2.57; 95% CI: 2.16–3.47; P < 0.002]. Conclusion According to the present study, the amount of prescriptions with antibiotics at community pharmacies is much higher than the WHO standard (20–26.2%). The antibiotics prescribed from Access group were 55.3%, which is slightly lower than WHO recommended level (60%). The prescribing of antibiotics was significantly correlated to the patient’s age, gender, and number of medications. The preprint version of the present study is available on Research Square with the following link: https://doi.org/10.21203/rs.3.rs-2547932/v1 .

Background: Antibiotics are more likely to trigger the development of antimicrobial resistance than other medications. Thus, they need to be prescribed, dispensed, and administered with greater caution. Timely evidence on medicine use, prescribing patterns, and the factors affecting the prescribing of an antibiotic would help decision-makers draft guidelines that would enable a more rational use of medicines. Methods: Prospective and cross-sectional study was conducted in seven community pharmacies in Dire Dawa to assess current prescribing practices, including antibiotic use and associated factors. Using stratified random sampling techniques, 1200 encounters were reviewed between October 1 and October 31, 2022 and SPSS version 27 was used for descriptive statistics and logistic regression. Results: The average medications per prescription was 1.96 and antibiotics were included in 47.83% of encounters while 43.03% were prescribed from Watch group. In 13.5% of the encounters, injections were administered. In multivariate models, patient age, gender, and the number of medications prescribed were all substantially related to the prescription of antibiotics. Antibiotics were about 2.5 times more likely to be prescribed to patients under the age of 18 than to subjects 65 and older (AOR: 2.51, 95% CI: 1.62-2.52; P <.001). Men were also more likely than women to receive an antibiotic prescription (AOR: 1.74, 95%CI: 1.18–2.33; P = 0.011). Subjects who those who received more than two drugs were 2.96 times more likely to receive an antibiotic (AOR: 2.96, 95%CI: 1.77–6.55; P = 0.003). The probabilities of prescribing antibiotics increased by 2.57 units for every unit increase in the number of medications (COR: 2.57; 95%CI: 2.16-3.47; P = 0.002). Conclusions: According to this study, the amount of prescriptions with antibiotics at community pharmacies much higher than the WHO standard (20–26.2%). Additionally, 13.5% of encounters involved an injection, which is comparable to the World Health Organization standard of 13.4-24.1%. The prescribing of antibiotics was significantly correlated with the patient's age, gender, and number of medications.