| Sumario: | Background: Inappropriate prescribing results in serious health outcomes in the elderly, increasing morbidity and mortality and wasting resources. In developing countries, physicians sometimes ignore parasitological diagnoses and presumptively treat fever as malaria, leading to overtreatment and drug resistance. Aim: The aim of this study was to determine the incidence, pattern, predictors and cost implications of inappropriate prescribing of antimalarials among elderly in‐patients. Methods: A prospective interventional study was performed over 18 months at the Department of Internal Medicine, in a tertiary care teaching hospital. Fever case management of all patients was studied to identify inappropriate antimalarial prescriptions without a confirmed diagnosis. Root cause analysis was performed to characterise inappropriate prescribing, along with economic implications. Results: During the study period, 403 fever cases were reported, of which 36% (n = 145) received a malaria test. Although 94% (n = 137) tests returned negative results, 32% (n = 44) of these patients were prescribed antimalarial drugs without a confirmed diagnosis, primarily monotherapy with injectable artesunate (61%) for an average of 4 days, resulting in 41% overdoses and 38% underdoses. The estimated direct cost associated with inappropriate prescribing was US$1291.67. Female bedridden patients who presented with fever associated with chills and rigors and hospitalised for longer were more likely to be irrationally prescribed antimalarials. Except for total leucocyte counts, all the other laboratory examinations were within normal limits for the study cohort (p < 0.05). Conclusion: Strict treatment guidelines for antibiotic use and a multidisciplinary team approach are required to prevent inappropriate prescribing and possible adverse effects without affecting health‐related quality of life.
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