Antibacterial drug quantities, prescription and dispensing practices among veterinary drug shops in Eastern Uganda

Abstract

Antibacterial overuse in food-producing animals is a recognised driver of antimicrobial resistance (AMR), particularly in low- and middle-income countries where regulation of veterinary drug use is limited. In Uganda, veterinary drug shops play a central role in the distribution of antibacterial drugs, yet data on quantities sold, prescription and dispensing practices remain scarce, especially at the regional level. This study quantified antibacterial sales over a 12-month period and assessed prescription and dispensing practices among veterinary drug shops in Eastern Uganda. A cross-sectional study was conducted between August 2024 and January 2025 across 36 districts of Eastern Uganda. A total of 139 veterinary drug shops were surveyed using a structured questionnaire adapted from human medicine practices. Retrospective data on antibacterial drug sales over the preceding 12 months were extracted from shop records. Sales quantities were analysed using OIE criteria, and prescribing and dispensing practices were summarised using percentages and frequencies. Overall, 90478.51 Kg (90.478 tonnes) of antibacterials were sold during the 12-month period. Tetracyclines (59.19%), macrolides (11.57%), and fluoroquinolones (8.86%) were the most commonly sold antibacterial classes. According to the EMA Antimicrobial Expert Group (AMEG) classification, 72.7% of the sold antibacterials were low-risk for resistance development, while 95.0% were categorised as Very Critically Important Antimicrobials (VCIA) under the OIE classification. Based on the WHO criteria, most antibacterials sold (72.6%) were considered highly important for human medicine. Prescription and dispensing practices were generally poor, characterised by widespread non-prescription sales, reliance on verbal and farmer-initiated prescriptions, in-shop prescribing by unqualified attendants, inadequate client education, poor record keeping and weak inventory control practices. The findings indicate substantial sales of antibacterials through veterinary drug shops in Eastern Uganda, suggesting a high potential for use in Livestock production. However, actual consumption per unit of animal biomass could not be estimated due to the absence of reliable animal population data. The study highlights the need for enforceable national veterinary prescribing guidelines, mandatory prescription requirements, regular inspections of veterinary drug shops, training of drug shop attendants and standardised record-keeping systems. Routine National and Regional surveillance of antibacterial sales is recommended to support antimicrobial stewardship and inform policy decisions. Develop and distribute standardised, practical national guidelines for veterinary prescription and dispensing.