Cross-sectional studyindependent cross-checkabstract checked I-ABX-131 standard review
Egyptian private clinics prescribe antibiotics in 4 of 5 infection visits
AWaRe antibiotic prescribing for common acute infections in private primary care in low-middle-income countries: a patient-level analysis using IQVIA prescriber surveys from Pakistan, Egypt and Indonesia.
Overview
Nguyen N et al.. BMJ Glob Health 2026 · PMID 42097706 · DOI 10.1136/bmjgh-2025-021139
In Egypt, 81% of infection consultations ended with an antibiotic, half from the 'Watch' group.
Does the study support the specific claim? Partly · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Measure antibiotic prescribing in private primary care
- How was the study done?
Prescriber survey analysis
- How many people, animals or samples were studied?
384,975 consultations
- What was actually found?
Very high prescribing
- How large was the observed effect?
Egypt 81.2%
- What do the results mean in everyday life?
Overuse is common in Egypt too
- What are the study's limitations?
Survey data; private sector
- What does it say about Elawady's specific claim?
Supports the overuse message regionally
- Do the results apply to Germany and Europe?
Egypt-specific
- What can explicitly not be concluded from this study?
What share was unnecessary
Scientific in-depth review
1. Full reference
- Authors
- Nguyen N et al.
- Journal
- BMJ Glob Health
- Year
- 2026
- Identifier
- PMID 42097706 DOI 10.1136/bmjgh-2025-021139
- Verification
- verified – PubMed efetch 2026-10-26 + Crossref
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Wellcome Trust; two authors employed by IQVIA (record).
2. Research question
How often are antibiotics, and which AWaRe classes, prescribed for common infections in private primary care?
3. Study design and population
- Study design
- Cross-sectional study – Cross-sectional analysis of prescriber surveys
- Population
Infection-related consultations, mostly private sector
- Country
Pakistan, Egypt, Indonesia
- Period
2017-2021
- Sample size
384,975 consultation records
- Inclusion and exclusion criteria
IQVIA Medical Data Index surveys
4. Methods and endpoints
- Exposure / intervention
Antibiotic prescribing
- Comparator
not applicable
- Endpoints
Share of consultations with antibiotics; Watch share
- Statistical methods
Mixed-effects regression
5. Actual results
- Results
Antibiotics prescribed in 82.0% of infection consultations in Pakistan, 81.2% in Egypt and 69.1% in Indonesia; Watch antibiotics 70.2%, 52.9% and 53.6% of prescriptions; non-EML antibiotics 39.9% in Egypt.
- Absolute risks
Egypt: 81.2% of infection consultations received an antibiotic
- Authors' conclusion
High total and Watch prescribing for common infections, including those that generally do not need antibiotics.
6. Strengths
- Large; includes Egypt
7. Weaknesses
- Commercial survey data; private sector
- Appropriateness not directly classified
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
IQVIA employees co-authors; market research data.
9. Assessment of the statistical interpretation
Descriptive.
10. Relevance to the specific claim
Shows overprescribing in Egypt, relevant for regional transfer of C-ABX-01.
11. Independent contrary findings
Not a US-style appropriateness estimate.
12. Transferability to Germany and Europe
Egypt-specific.
13. Overall methodological judgement
Overuse is also a problem in Egypt.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | high |
| Directness | direct |
| Reproducibility | unknown |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Appropriateness by diagnosis.