Antibiotic Prescribing Pattern in inpatient Department using WHO AWaRe Classification and WHO Prescribing Indicators in a multi-specialty hospital

Abstract

Background: Antibiotics are essential for combating bacterial infections in both humans and animals, functioning by either eliminating bacteria or halting their growth. Although lifesaving, the overuse of antibiotics has contributed to the emergence of antibiotic resistance, a serious global health concern. The WHO updated its Essential Medicines List in 2019, organizing antibiotics into three categories: Access, Watch, and Reserve (AWaRe). The goal of the AWaRe classification is to ensure at least 60% of global antibiotic use falls under the Access group, promoting proper usage and curbing resistance. WHO Core Drug Use Indicators are used to identify issues in drug utilization, evaluate the performance of healthcare institutions, and guide the implementation of antibiotic stewardship programs. Methodology: This study aimed to evaluate the antibiotic prescribing patterns on patients admitted in a multi-specialty hospital, based on WHO AWaRe Classification and WHO Prescribing Indicators. Conducted as a cross-sectional observational study, data from 152 prescriptions over three months were analyzed. The study included inpatients aged 18 and above, from both genders, each receiving at least one antibiotic. Data were analyzed using descriptive statistics, employing the WHO AWaRe Classification system and WHO Prescribing Indicators to assess prescription patterns. Results: Across 152 prescriptions, 1,413 drugs were prescribed, averaging 9.2 drugs per prescription, including 319 antibiotics, with an average of 2 antibiotics per prescription. Of the antibiotics prescribed, 90.2% were from the WHO Essential Medicines List, 11.2% were prescribed by generic name, and 98.7% were in injectable form. Male patients accounted for 68% of prescriptions, with the largest age group being 40–50 years (27 prescriptions) and a mean age of 49.7 years. The most frequently prescribed antibiotics were ceftriaxone (68, 21.3%), metronidazole (64, 20.0%), and amoxicillin/clavulanic acid (37, 11.6%). Cephalosporins were the most commonly prescribed class (81, 25.4%). Most antibiotics belonged to the Watch group (198, 62%), followed by the Access group (116, 36.4%), with five antibiotics from the Reserve group. Conclusion: The study highlights the need to shift prescribing practices toward Access antibiotics and emphasizes the importance of using generic and essential drugs, as guided by the WHO Prescribing Indicators and AWaRe framework, to optimize antibiotic use and combat resistance.