Medicines in livestock production are certain as they are essential for the treatment or prevention of diseases, and improvement of growth and productivity [1]. Antimicrobial drugs are used for the treatment or prevention of bacterial diseases in humans, plants, and animals. It is also used for growth promotion in animals [2,3].

The concept of rational drug use is age old, as evident by the statement made by the Alexandrian physician Herophilus 300 B.C that is “Medicines are nothing in themselves but are the very hands of god if employed with reason & prudence”. The rational use of drugs has gained significant medical, socioeconomic, and legal importance in recent times [4].

“Medicine use is rational (appropriate, proper, correct) when patients receive the appropriate medicines, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost both to them and the community. Irrational (inappropriate, improper, incorrect) use of medicines is when one or more of these conditions is not met” [5]. Inappropriate use of drugs can cause ineffective treatment, unnecessary waste of resources, and harm to patients [6–8].

Inappropriate use of veterinary medicines in food animals is a cause of public health concern as residues from animal products can cause health issues [9–13].

The presence of drug residues in animal products is influenced by various factors, including the physicochemical properties of the drugs and the biological processes of the animals and their products. These residues pose serious public health risks, such as hypersensitivity reactions, cancer, mutagenicity, reproductive issues, bacterial resistance, and disruption of the normal intestinal flora [14]. Cooking methods can reduce residues, but not always to safe levels [9–13].

To prevent residue risk, the drug must be used rationally. That is, they should be used only when truly indicated disease, in the right way, at the right time, in the right dose, and with the appropriate withdrawal period [15]. Regulatory authorities set maximum residue limits to control residues, this emphasize monitoring programs and sensitive analytical methods for food safety [9–13].

Ethiopia boasts the largest number of livestock in Africa, with 66 million head of cattle, 38 million sheep, 46 million goats, 41.35 million poultry, 2.14 million horses, 10 million donkeys, 0.36 million mules, 7 million camels, and 5.98 million hives [16].

Despite this huge livestock population, Ethiopia’s livestock resources are underutilized due to various factors such as diseases, droughts, infrastructure issues, malnutrition, improper husbandry, lack of trained personnel [17–20], highlighting the need for disease prevention and control measures [18].

Studies in Ethiopia have shown irrational drug use in veterinary clinics of Bishoftu, Adama District, Mojo, and Gondar [21–24], respectively, in central and northwest Ethiopia.

Previously, there was a study in Gondar town veterinary clinic in combination with the University of Gondar and Azezo veterinary clinics by Berihun et al. [24], but the data taken from this clinic was too shallow and used 12 months of recorded data from February 01, 2014 to January 01, 2015 retrospectively with low sample size (250 samples), but in present study 1717 samples from 20,688 prescriptions written for a 5-year period (January 02, 2015 to January 01, 2020) were taken with cross-sectional and retrospective study using systematic random sampling method, this can display enough drug using trend information. Therefore, this study evaluates veterinary drug use patterns in livestock and shows the public health significance of irrational drug use in Gondar town veterinary clinic, north west Ethiopia.

A total of 1,717 patients were evaluated from the case registry book of Gondar town veterinary clinic. A retrospective study revealed that 2,117 drugs were prescribed, with an average of 1.23 drugs per prescription and a maximum of 3 drugs per prescription (Table 1); this indicates polypharmacy is no longer used.

Endectocide=drugs that can treat both endo-parasites and ecto-parasites.

In this study, the percentage of drugs prescribed by generic name was 100% (Table 1) and the percentage of drugs prescribed from Ethiopia’s National Veterinary Drug List was assessed; however, there was no veterinary drug list available in Gondar town veterinary clinic.

From the 2,117 total drug prescriptions, 811 (47.2%) were for antimicrobials, 363 (21.1%) were for anthelmintics, 229 (13.3%) were for endectocide with antimicrobials, and 174 (10.1%) were for endectocide (Table.1).

The pattern of veterinary drugs in this clinic was antimicrobial for 1,182 (55.7%), anthelmintic for 481 (22.7%), endectocide for 426 (20.1%), and others for 28 (1.3%) given to treat animal patients. Penicillin G-streptomycin fixed-dose 409/1,182 (34.6%), short-acting oxytetracycline 401/1,182 (33.9%) and long-acting oxytetracycline 193/1,182 (16.33%) were the most commonly prescribed antibacterial drugs, while albendazole 395/481 (82.1%) was the most commonly prescribed anthelmintic (Table.2).

The study also examined the relationship between drug administration and the preliminary diagnosis of diseases to determine if drugs were being used appropriately. The findings revealed that antimicrobials were prescribed for viral diseases (1.4%), ectoparasitic diseases (0.2%), endoparasitic diseases (0.8%), metabolic diseases (0.3%), and fungal diseases (0.1%). Anthelmintics were administered for bacterial diseases (0.1%) and ectoparasitic diseases (0.5%), while endectocide was prescribed for bacterial diseases (0.6%), protozoal diseases (0.1%), and metabolic diseases (0.1%). These prescription patterns were deemed irrational based on a p-value of 0.000 (Table 3).

AM=Antimicrobial, AH=Anthelmintic, E=Endectocide, and O=Others.

X²=1954.980, p-value=0.000.

All cases encountered in Gondar town veterinary clinic were provisionally diagnosed without correct laboratory corroboration and then the drug was administered; the route of administration for the prescribed drug was not indicated in 2013 out of 2117 cases (95.1%).

A study of the educational background of drug prescribers revealed that the prescribed drugs were prescribed by animal health assistants or diploma level in 80% of the cases and 20% by veterinarians. From 2,117 drugs, 283 (13.4%) were prescribed without a regimen indicated and 61 (2.9%) drugs were prescribed with incorrect dosing regimens.

In addition, other problems related to rational drug use included the presence of a few essential drugs, lack of standard prescription forms, standard case registration book, and standard veterinary drug treatment guidelines in the clinic, poorly organized case registers, and lack of complete information on animal age, observed history and clinical signs, prescribed drug doses, dosages, routes of administration, and regimens were mentioned. Drugs administered were done without taking into account the weight of the animals, which may lead to under- or over-dosing of drugs, and these reveal irrational use of drugs. Low inventories of key essential drugs were observed, leading to the overuse of drugs.

The average number of drugs per prescription at Gondar town veterinary clinic was 1.23, with a maximum of 3 drugs per prescription. This result is similar to studies conducted in CVMA-VTH and Ada district veterinary clinic that reported 1.23 [21], in Adama district veterinary clinic that reported 1.25 [22], in the Mojo veterinary clinic that reported 1.11 average number of drugs per prescription’ [23]. In North India, the non-polypharmacy index was reported to be 1.19, within the optimal range, signifying a lower likelihood of polypharmacy concerns [27].

However, it is lower than 1.95 at Debre Tabor Comprehensive Specialized Hospital [28], 2.5 at a referral and teaching hospital in Northeast Ethiopia [29], 1.8 at Finoteselam and 2.05 at Asirade Zewudie hospitals [30], 1.46 at a referral hospital in Ethiopia [31], 2.3 in Lumame Primary Hospital [32] and 2.84 at Tikur Ambessa Specialized Hospital [33]; where the average number of drugs prescribed per prescription falls within the range of 1–5 drugs in the hospitals assessed; the WHO human standard is 1.6–1.8 [34], indicating no polypharmacy problem. This study result indicates a lower average number of drugs per prescription than the WHO standard indicating that polypharmacy is no longer used.

Minimizing polypharmacy in veterinary medicine supports optimal animal health outcomes, mitigates risks of antibiotic resistance, promotes responsible drug use, and contributes to efficient healthcare practices beneficial to both animal and public health [35].

The low average number of drugs per prescription may be due to the difficulty in obtaining drugs or to prescribers receiving proper training on the complications of drug combinations. However, the low numbers in this study indicate a lack of drugs in the clinics rather than proper training of prescribers; since few numbers of essential drugs and repeated use were observed.

In this study, the percentage of drugs prescribed by generic name was 100% (Table 1) in line with the study in Ateso veterinary clinic [36] and in general outpatient departments of the public Arbaminchi and Chencha hospitals show all drugs were prescribed using generic names [37].

Whereas; higher than 90.1% in Bishoftu [21], 97.4% in Adama district [22], and 91.8% in Mojo Veterinary Clinic [23]. Also greater than 90.61% in a public hospital in eastern Ethiopia [38].

Proper prescription and use of generic antibiotics can help mitigate antibiotic resistance by ensuring consistent, appropriate treatment regimens [39]; whereas prescription and use of brand name drugs prime high costs may lead to improper dosing or incomplete courses of treatment, contributing to antibiotic resistance in animals and potentially affecting human health through zoonotic disease transmission [40].

The percentage of drugs prescribed from Ethiopia’s National Veterinary Drug List was assessed; however, there was no veterinary drug list available in Gondar town veterinary clinic; which is similar with Batu and Arsi-Negelle district veterinary clinics [41], Ateso veterinary clinic [36] and two of three veterinary clinics of Gondar town [24] which have no national veterinary drug list availability. Non-availability of drugs from National Veterinary Drug List can leads to Improper Alternative use; farmers and veterinarians may resort to using inappropriate or less effective drugs, potentially increasing the misuse and overuse of antibiotics, which can contribute to the development of antibiotic-resistant bacteria [42], this can be transferred to humans through direct contact with animals, consumption of animal products, or environmental contamination, complicating the treatment of infections in humans [43].

The most commonly prescribed antibiotics were oxytetracycline 83.6% and penicillin G streptomycin fixed dose 13.8% [21], oxytetracycline 73.90% and penicillin G streptomycin fixed dose 22.60% [22], oxytetracycline 86.14% and penicillin G streptomycin fixed dose 13.56% [23] these are similar prescription tendency to the present study oxytetracycline 50.23% (short-acting + long-acting) and Penicillin G-streptomycin fixed-dose 34.6%.

This result indicate that average antimicrobials prescription rate was similar with 57.87% in selected public hospitals of eastern Ethiopia [38] and 58% in Hawassa University Hospital [44]. But higher than 46.4% in Adama District Veterinary clinic [22] and 48.67% in Arba Minch [37]; and lower than 64% in Pakistan [45]; 60.41% in Mojo Veterinary clinic [23] and 60.20% in Chencha Hospitals [37].

However, based on antibiotics prescribed in humans 20.0%–26.8% [46], this result indicate that average antimicrobials prescription rate was higher. This higher prescription could be attributed to lack of disease awareness, unavailability of diagnostic aids for confirmatory tests, lack of appropriate drugs, and lack of prescriber knowledge.

Overprescribing antimicrobials can lead to the development of antibiotic-resistant bacteria. These resistant strains can spread within the community and healthcare settings, making infections harder to treat [43].

Antimicrobials were irrationally prescribed to treat viral diseases (16.2%) and surgical cases (5.6%), and anthelmintic in bacterial diseases (2.9%) and surgical cases (0.9%) [22]. Also in study by Mojo et al. [23], antimicrobials were prescribed for viral (26.2%), parasitic (8.6%), surgical (0.2%), and metabolic (0.9%) diseases and anthelmintic in bacterial (28.7%), metabolic (7%) and viral (3.8%) diseases; parallel to this anthelmintic (44.3%) were also improperly prescribed for the treatment of non-parasitic diseases at the University of Gondar veterinary clinic [47].

In the same way; this study examined the relationship between drug administration and the preliminary diagnosis of diseases as a result irrational prescription patterns were observed. However, the percentages of irrational prescription patterns were unlike with other studies. The variation of percentage of irrational prescription pattern in different study may be due to the unavailability of confirmatory diagnosis (laboratory support) or improper diagnosis of diseases; diverse in the availability of essential drugs, lack of selection of appropriate drugs, the experience of using drugs as supportive treatment or prophylaxis, availability of standard veterinary drug treatment guideline and individual knowledge variation about clinical signs of diseases.

In this study, inappropriate use of these drugs may be due to prescriber’s lack of knowledge about the appropriate drug for the suspected case, drug unavailability, and owner’s assumptions about antimicrobial injections; this drug use pattern leads to high public health significance.

Irrational practices, such as over-prescription, inappropriate dosages, and incorrect durations, can lead to various detrimental outcomes. These include limited efficacy, increased risk of drug resistance and residues, wastage of resources, and psychosocial impacts. The misuse of antimicrobials in food-producing animals, especially in sectors such as poultry, cattle, and pigs, poses a significant threat to human health due to potential exposure through the food chain [48].

The public health importance of the improper use of veterinary drugs is significant [15,49–51] leading to various consequences such as the presence of antimicrobial residues, the development of drug resistance, hypersensitivity reactions, carcinogenicity, mutagenicity, teratogenicity, bone marrow suppression, destruction of normal gut flora [52], and therapeutic failure [48]. Regulating the use of antimicrobials and other medications in livestock is vital for preventing adverse effects on consumers and mitigating the emergence of antimicrobial resistance [54]. This is because antimicrobial resistance is linked not only to the improper, excessive, and indiscriminate use of antimicrobial drugs in plants, humans, and animals, but also to their use as growth enhancers in livestock and their extensive application in industry (such as in the production of specific goods or for the decontamination of machinery, tools, and equipment) [40]. All of these uses generate direct waste for disposal and indirect waste in packaging and by-products that affect environmental health, since when discarded they can modify the ecological balance of terrestrial and aquatic environments by interfering with the natural microbial flora [55].

Infections caused by intermediate microorganisms generate greater costs in the treatment of human patients, in addition to the impact on the social security system caused by absence from work and the resulting deaths [56]. Adding all these factors to the loss of food related to contamination by bacterial microorganisms and the presence of residues of antimicrobial medicines in food and water intended for human consumption, we are able to understand that antimicrobial resistance (AMR) is a subject that involves several aspects that permeate the human, animal and environmental health, in other words, it is a subject that must be approached from the perspective of one health [39].

Monitoring drug residues in food is essential for ensuring adherence to safety stan­dards and safeguarding public health [48].

The outcomes of inappropriate drug usage in food animals can result in reduced effectiveness, higher chances of adverse effects, and the development of drug resistance, which poses a danger to public health and food safety [49].

Symptomatic treatment of viral infections and adequate feed and water are better than routinely used antimicrobials, which may exacerbate drug resistance. Antimicrobials for endo-parasitism and ecto-parasitism are inappropriate as they must bind to the microorganism’s binding site, preventing drug resistance.

The route of administration of 95.1% of prescribed drug was not indicated in this finding, which is similar with 96.5% by Mojo et al. [23], 99.1% by Beyene et al. [22] and 98.9% by Beyene et al. [21] which have its own contribution for the presence of irrational drug use.

Incorrect drug administration can reduce efficacy and exaggerate pharmacological reactions, such as toxicity and unexpected side effects. Irrational prescribing of antibiotics is primarily due to inadequate infection recognition, improper route selection, and incorrect selection of doses and regimens [21].

This study found that 80% of drug prescribers were animal health assistants or held diplomas, while only 20% were veterinarians, which is consistent with studies conducted at Mojo Veterinary clinic 67.9% and 32.06% [23], Adama Veterinary clinic 88.1% and 11.9% [22], and at VTH-CVMA and Ada District Veterinary clinic 70.8% and 29.2% [21] of the prescriptions were done by animal health assistants or diploma levels and veterinarians, respectively. This indicates that the level of education of prescribers of veterinary drugs is low and requires attention to avoid treatment failure, misuse of drugs, and development of drug resistance.

Federal Constitution of Ethiopia Decree No. 728-2011 stipulates that veterinary drugs shall only be prescribed by veterinarians. It also states that veterinarians must follow prescribing procedures and prescribe veterinary drugs on standard prescription forms [57].

This finding revealed that 13.4% of drugs were prescribed without a regimen indicated and 2.9% drugs were prescribed with incorrect dosing regimens, also similar with routes of drug administration and duration of treatment in CVMA-VTH and Ada district veterinary clinics were not fully specified for most cases [21] and Adama district veterinary clinic 99.1% of prescribed drugs route of administration and 93.5% length of treatment of encounters was not specified [22].

In other study, 34.7% were adequately labeled with dosage regimens [58]. Additionally, another study highlighted that 286/480 (59.6%) were unadjusted dose [59]. This indicates that there gives little attention for regimen and dose records which leads to irrational drug uses.

No laboratory tests were performed at all in this clinic, similar to Adama District Veterinary Clinic there was no laboratory test done [22], also in line with 98.2% and 96.6% of patients admitted to Mojo Veterinary Clinic [23] and CVMA-VTH and Ada District Veterinary Clinic [21] respectively were received empirical treatment without receiving a correct definitive diagnosis (laboratory support). This indicates that affected animals are being treated based solely on a tentative diagnosis. This implies that affected animals either not receiving targeted treatments or being administered medications inappropriately, often without understanding the exact cause of the disease. This can lead to significant public health concerns regarding drug residues.

The findings on veterinary drug prescribing in this study showed that the lack of proper diagnosis of disease and selection of appropriate drugs, lack of laboratory testing, low level of education of prescribers, presence of a few essential drugs, lack of a national veterinary drug list and standard veterinary drug treatment guidelines, lack of standard prescription forms, and case registry books. On the other hand, polypharmacy and generic drug prescribing are not considered a problem. Therefore, all important patient-related information should be well documented in standard case forms and case registration books. In order to reduce inappropriate use of medicines, only veterinarians must be prescribe medications, the supply management of medicines should be strictly controlled and the availability of key essential medicines should be improved. Appropriate drugs should be prescribed in appropriate doses, routes, and regimens. Laboratory support should be appointed and laboratory equipment, chemicals, and reagents enriched to confirm provisionally diagnosed diseases. Governments, private veterinary practitioners, and animal owners should promote the rational use of pharmaceuticals. Veterinarians should be made aware of the irrational use of veterinary drugs and their public health implications. These all improvements can lead to rational use and reduce the public health effects of drug residue from food animals..

The authors are expressing their gratitude to Wollo University for providing budget support, as well as the Gondar town veterinary clinic experts and veterinarians for their assistance in facilitating the research operations.

The authors declare that there are no competing interests.

This study was funded by the Wollo University.

The authors agreed this work, data, images, or any related information to be published.

The data used to support the findings of this study are included with in the article.

Since this study used secondary data no need of ethical approval.

Teklu Yitbarek was responsible for drafting, research, formal analysis, data curation, review, and editing.

Selamawit Fentahun was responsible for conception, advice, supervision, and careful comments.