Antibiotic use in smallholder poultry farming may contribute to antimicrobial resistance in Ghana, yet evidence on patterns in the Ashanti Region remains limited. A retrospective cross-sectional analysis was conducted using 1,202 poultry farm complaint records submitted to the Ashanti Regional Veterinary Laboratory between 2020 and 2025. Data on bird type, primary clinical presentation, reported antibiotic use, antibiotic class, and Antimicrobial Expert Group categorisation were extracted and analysed using descriptive statistics, chi-square tests, and multivariable binary logistic regression. Antibiotic use was reported in 329 cases (27.4%). Mortality-related presentations were most frequent (19.6%), followed by general/non-specific signs (18.0%) and gastrointestinal presentations (16.6%). Aminoglycosides (n = 109), penicillins (n = 89), and tetracyclines (n = 78) were the most frequently identified antibiotic classes. Category C (Caution) antibiotics predominated among classified records. Primary clinical presentation was independently associated with reported antibiotic use; multisystemic signs (adjusted odds ratio [aOR] = 1.75), gastrointestinal presentations (aOR = 1.92), and respiratory presentations (aOR = 1.91) had significantly higher odds of reported antibiotic use. Antimicrobial stewardship, improved veterinary extension services, and enhanced diagnostic capacity are needed to promote prudent antibiotic use.
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